Central nervous system complications in renal transplant recipients in a tropical environment

Renal transplant recipients are at risk of developing various infectious an d non-infectious complications affecting the central nervous system (CNS). There is paucity of data regarding the spectrum of CNS complications and th e epidemiology of infective agents varies according to geographical locatio n. We retrospectively studied the spectrum of CNS complications seen in 792 renal allograft recipients followed up at this tertiary care centre in nor th India over a 19-year period. Autopsy findings of 78 allograft recipients who died in the hospital were also reviewed and included. The brain was ex amined in 22 of these patients. Overall, 79 (10%) patients developed some f orm of CNS dysfunction with a mortality rate of 60.8%. CNS infections occur red in 31 renal allograft recipients (3.9% of total) and accounted for the largest group (39.2%). Fungi were the commonest etiological agents (21 pati ents) and were associated with a 70% mortality, with cryptococcal meningiti s occurring in 12, mucormycosis in six, aspergillosis in one, and other unu sual fungal infections in the remaining two patients. All patients with muc ormycosis had a fatal outcome. The second largest group comprised of patien ts with non-uremic encephalopathies (23 patients, 29.1%) with metabolic enc ephalopathy occurring in 13. toxic encephalopathy in nine and hypertensive encephalopathy in one patient) and was associated with an overall mortality rate of 60.9%. Cerebrovascular accidents occurred in 12 patients (15.2%) a nd were associated with a mortality of 91.7%. Other CNS complications inclu ded treatment related complications in four (5.1%), primary CNS lymphomas i n three (3.8%), and miscellaneous complications in six patients (7.6%). Pat ients with non-cryptococcal fungal infections of the CNS, hepatic and toxic encephalopathy and those with cerebrovascular accidents had the worst outc ome. There was no relationship between the development of infection or stro ke and the type of maintenance immunosuppression used. We conclude that com plications involving the CNS occur in 10% of all renal transplant recipient s and are associated a with high mortality, warranting early diagnosis and aggressive treatment. (C) 2001 Elsevier Science B.V. All rights reserved.