CENTRAL-NERVOUS-SYSTEM COMPLICATIONS AFTER LUNG TRANSPLANTATION

Purpose: This study describes the central nervous system (CNS) events after lung transplantation. Methods: A chart review of all lung transp lant recipients (LTR) to collect the clinical and neuroimaging data fo r CNS events defined as seizures, severe headaches, confusion, or stro ke. Results: Twenty-six patients of 100 LTRs from 1990 through 1995 ha d a CNS event; more than one event occurred in 5 patients for a total of 32 events. Severe headache was most common, occurring in 14 patient s, followed by seizures in 10, stroke in 5, and confusion in 3. The CN S event was related to infection in three of the 26 patients. Of all e valuations performed, magnetic resonance imaging (MRI) identified the most abnormalities, the most common being white matter changes consist ent with cyclosporine toxicity. Cyclosporine levels were elevated in s lightly more than half of the patients. Hypomagnesemia was present in three of 10 patients with seizures. Prognosis for recovery from these complications was good, with only five patients having ongoing problem s with headaches, one requiring long term anticonvulsant therapy, thre e having minor or no limitations from stroke and no long-term problems with confusion. One patient with seizures resulting from an aspergill oma died. Conclusion: CNS events occur commonly in LTRs, mostly relate d to cyclosporine toxicity or infection. MRI identifies more abnormali ties than computed tomography. These events were not consistently asso ciated with documented high cyclosporine levels and hypomagnesemia. In spite of significantly abnormal MRIs, the functional outcome is favor able.