TY - JOUR
T1 - Neurologic Complications of Transplantation
AU - Dhar, Rajat
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Neurologic disturbances including encephalopathy, seizures, and focal deficits complicate the course 10–30% of patients undergoing organ or stem cell transplantation. While much or this morbidity is multifactorial and often associated with extra-cerebral dysfunction (e.g., graft dysfunction, metabolic derangements), immunosuppressive drugs also contribute significantly. This can either be through direct toxicity (e.g., posterior reversible encephalopathy syndrome from calcineurin inhibitors such as tacrolimus in the acute postoperative period) or by facilitating opportunistic infections in the months after transplantation. Other neurologic syndromes such as akinetic mutism and osmotic demyelination may also occur. While much of this neurologic dysfunction may be reversible if related to metabolic factors or drug toxicity (and the etiology is recognized and reversed), cases of multifocal cerebral infarction, hemorrhage, or infection may have poor outcomes. As transplant patients survive longer, delayed infections (such as progressive multifocal leukoencephalopathy) and post-transplant malignancies are increasingly reported.
AB - Neurologic disturbances including encephalopathy, seizures, and focal deficits complicate the course 10–30% of patients undergoing organ or stem cell transplantation. While much or this morbidity is multifactorial and often associated with extra-cerebral dysfunction (e.g., graft dysfunction, metabolic derangements), immunosuppressive drugs also contribute significantly. This can either be through direct toxicity (e.g., posterior reversible encephalopathy syndrome from calcineurin inhibitors such as tacrolimus in the acute postoperative period) or by facilitating opportunistic infections in the months after transplantation. Other neurologic syndromes such as akinetic mutism and osmotic demyelination may also occur. While much of this neurologic dysfunction may be reversible if related to metabolic factors or drug toxicity (and the etiology is recognized and reversed), cases of multifocal cerebral infarction, hemorrhage, or infection may have poor outcomes. As transplant patients survive longer, delayed infections (such as progressive multifocal leukoencephalopathy) and post-transplant malignancies are increasingly reported.
KW - Immunosuppressive agents
KW - Organ transplantation
KW - Posterior reversible encephalopathy syndrome
KW - Postoperative complications
KW - Stem cell transplantation
UR - http://www.scopus.com/inward/record.url?scp=85014108800&partnerID=8YFLogxK
U2 - 10.1007/s12028-017-0387-6
DO - 10.1007/s12028-017-0387-6
M3 - Review article
C2 - 28251577
AN - SCOPUS:85014108800
VL - 28
SP - 4
EP - 11
JO - Neurocritical Care
JF - Neurocritical Care
SN - 1541-6933
IS - 1
ER -