eMedicine Specialties > Neurology > Critical Care Neurology

Neurologic Complications of Organ Transplantation: Follow-up

Author: Sasa Zivkovic, MD, MSc, Assistant Professor, Department of Neurology, Division of Neuromuscular Diseases, University of Pittsburgh and VA Pittsburgh Healthcare System
Contributor Information and Disclosures

Updated: Jan 25, 2008

Follow-up

Prognosis

  • Most transplant recipients with neurologic complications recover successfully, and the outcome is determined by the function of the allograft. Nevertheless, patients with anoxic encephalopathies, brain hemorrhage, and CNS infections frequently have very poor outcomes.
    • Fungal CNS infections have a high mortality rate in immunosuppressed transplant recipients (75%) and may be very difficult to treat. Timely diagnosis may improve outcome. Similarly, rare patients with progressive multifocal leukoencephalopathy (PML) also have very high mortality rates (>90%).
    • Patients with CIM/CIP may face prolonged recovery, but the outcome is determined by underlying medical condition and allograft status.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Immunosuppressed transplant recipients are at high risk for opportunistic CNS infections. Clinical presentation may be very subtle, with only a mild confusion and headache at onset. Nevertheless, these patients may worsen quickly, and timely diagnosis may improve the outcome. Therefore, consider lumbar puncture and cerebrospinal fluid studies early in the course, if it can be done safely. Patients may require repeated lumbar punctures, particularly with infectious agents that may be difficult to culture and diagnose.
  • Obtaining detailed history may be crucial in establishing diagnosis, particularly with exposure to endemic pathogens or other risk factors for opportunistic CNS infections.
  • Patients with calcineurin inhibitor neurotoxicity (cyclosporine, tacrolimus) frequently improve when one medication is substituted for another.
 


More on Neurologic Complications of Organ Transplantation

Overview: Neurologic Complications of Organ Transplantation
Differential Diagnoses & Workup: Neurologic Complications of Organ Transplantation
Treatment & Medication: Neurologic Complications of Organ Transplantation
Follow-up: Neurologic Complications of Organ Transplantation
Multimedia: Neurologic Complications of Organ Transplantation
References
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Further Reading

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Keywords

opportunistic infection, immunosuppression, central nervous system infection, CNS infection, organ transplant, solid organ transplantation, kidney transplantation, liver transplantation, heart transplantation, lung transplantation, intestinal transplantation, posttransplant immunosuppression, opportunistic infection

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Contributor Information and Disclosures

Author

Sasa Zivkovic, MD, MSc, Assistant Professor, Department of Neurology, Division of Neuromuscular Diseases, University of Pittsburgh and VA Pittsburgh Healthcare System
Sasa Zivkovic, MD, MSc is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

Medical Editor

Norman C Reynolds Jr, MD, Professor, Department of Neurology, Medical College of Wisconsin
Norman C Reynolds Jr, MD is a member of the following medical societies: American Academy of Neurology, American Chemical Society, American Clinical Neurophysiology Society, Association of Military Surgeons of the US, Movement Disorders Society, Sigma Xi, and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Novartis Consulting fee Review panel membership

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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