Neurocritical Care in Transplant Patients

This review aims to summarize important aspects of clinical presentations, updates on diagnostic methods, and current treatment options for the most common neurologic complications following solid organ and hematopoietic stem cell transplants.

Central nervous system (CNS) infections in the setting of immunosuppressants remain a prevalent complication in transplant recipients with high mortality. Growing evidence on CNS infections has enhanced understanding of the time of their onset, aiding in diagnosis. New treatment evidence for progressive multifocal encephalopathy has been identified and should be evaluated through prospective studies. While osmotic demyelination syndrome (ODS), posterior reversible encephalopathy syndrome (PRES), and post-transplant lymphoproliferative disorders (PTLD) have a high reported incidence in transplant recipients, the treatment options remain limited and heavily rely primarily on preventative measures and anecdotal reports. This indicates a significant knowledge gap and a need for prospective studies.

Neurologic complications in transplant recipients include encephalopathy, seizures, CNS infections, ODS, PRES, immunosuppressant neurotoxicity, cerebrovascular and neuromuscular complications, and PTLD. A main challenge is to balance optimal immunosuppression against the risk of graft rejection and neurologic complications. While there has been an increasing body of literature describing the epidemiology and clinical spectrum of these complications, more clinical studies are needed to guide management in this medically complex population.