title: Neurologic Complications of Transplantation.
abstract: 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.
authors.affiliation: Department of Neurology (Division of Neurocritical Care), Washington University in St. Louis School of Medicine, 660 S Euclid Avenue, Campus Box 8111, Saint Louis, MO, 63110, USA. dharr@wustl.edu.
authors.forename: Rajat
authors.identifier: 0000-0002-5167-5097
authors.initials: R
authors.lastname: Dhar
mesh_terms: D002494:Central Nervous System Infections / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016377:Organ Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012640:Seizures / Q000453:epidemiology / Q000209:etiology*; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data
chemical_list: D007166:Immunosuppressive Agents
keywords: Immunosuppressive agents; Organ transplantation; Posterior reversible encephalopathy syndrome; Postoperative complications; Stem cell transplantation