Neurologic Emergencies in Transplant Patients

  • Jeffrey Brent Peel
  • Lauren K. NgEmail author


Neurological complications contribute significantly to morbidity and mortality in patients with organ transplantation. Severe neurotoxicity from immunosuppressive medications, central nervous system infections, stroke, and seizure constitute true neurological emergencies. Early recognition and understanding of diagnostic and treatment principles are required of all specialties involved in the care of the patient with organ transplantation. This chapter presents a practical approach to the emergency diagnosis of management of acute neurological problems in patients with arm transplantation.


Organ transplant Neurotoxicity of immunosuppressive agents 


  1. 1.
    Shah M. Inpatient neurologic consultation in solid organ transplant patients. Semin Neurol. 2015;35(6):699–707.CrossRefGoogle Scholar
  2. 2.
    Asai A, Qiu J, Narita Y, et al. High level calcineurin activity predisposes neuronal cells to apoptosis. J Biol Chem. 1999;274(48):34450–8.CrossRefGoogle Scholar
  3. 3.
    Patchell RA. Neurological complications of organ transplantation. Ann Neurol. 1994;36(5):688–703.CrossRefGoogle Scholar
  4. 4.
    Pustavoitau A, Bhardwaj A, Stevens R. Neurological complications of transplantation. J Intensive Care Med. 2011;26(4):209–22.CrossRefGoogle Scholar
  5. 5.
    Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914–25.CrossRefGoogle Scholar
  6. 6.
    Burnett MM, Hess CP, Roberts JP, et al. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin Neurol Neurosurg. 2010;112(10):886–91.CrossRefGoogle Scholar
  7. 7.
    Dhar R, Human T. Central nervous system complications after transplantation. Neurol Clin. 2011;29(4):943–72.CrossRefGoogle Scholar
  8. 8.
    Conti DJ, Rubin RH. Infection of the central nervous system in organ transplant recipients. Neurol Clin. 1988;6(2):241–60.CrossRefGoogle Scholar
  9. 9.
    Lee DH, Zuckerman RA, AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplantation: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transpl. 2019;12:e13526.[Epub ahead of print].Google Scholar
  10. 10.
    Senzolo M, Ferronato C, Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22(3):269–78.CrossRefGoogle Scholar
  11. 11.
    Kim JM, Jung KH, Lee ST, et al. Central nervous system complications after liver transplantation. J Clin Neurosci. 2015;22(8):1355–9.CrossRefGoogle Scholar
  12. 12.
    EFm W, Plevak DJ, Rakela J, Wiesner RH. Clinical and radiologic features of cerebral edema in fulminant hepatic failure. Mayo Clin Proc. 1995;70:119–24.CrossRefGoogle Scholar
  13. 13.
    Brandsaeter B, Hockerstedt K, Friman S, et al. Fulminant hepatic failure: outcome after listing for highly urgent liver transplantation: 12 years experience in the Nordic countries. Liver Transpl. 2002;8:1055–62.CrossRefGoogle Scholar
  14. 14.
    O’grady J. Modern management of acute liver failure. Clin Liver Dis. 2007;11:291–303.CrossRefGoogle Scholar
  15. 15.
    Maloney PR, Mallory GW, Atkinson JL, Wijdicks EF, Rabinstein AA, Van Gompel JJ. Intracranial pressure monitoring in acute liver failure: institutional case series. Neurocrit Care. 2016;25(1):86–93. CrossRefGoogle Scholar
  16. 16.
    Pizzi M, Ng L. Neurologic complications of solid organ transplantation. Neurol Clin. 2017;35:809–23.CrossRefGoogle Scholar
  17. 17.
    Singh TD, Fugate JE, Rabinstein AA. Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol. 2014;21(12):1443–50. Epub 2014 Sep 15.CrossRefGoogle Scholar
  18. 18.
    Graff-Radford J, Fugate JE, Kaufmann TJ, Mandrekar JN, Rabinstein AA. Clinical and radiologic correlations of central pontine myelinolysis syndrome. Mayo Clin Proc. 2011;86(11):1063–7. Epub 2011 Oct 13.CrossRefGoogle Scholar
  19. 19.
    Christie JD, Edwards LB, Kucheryavaya AY, et al. The registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult lung and heart- lung transplant report–2011. J Heart Lung Transplant. 2011;30(10):1104–22.CrossRefGoogle Scholar
  20. 20.
    Shigemura N, Sclabassi RJ, Bhama JK, et al. Early major neurologic complications after lung transplantation: incidence, risk factors, and outcome. Transplantation. 2013;95(6):866–71.CrossRefGoogle Scholar
  21. 21.
    Pierson DJ. Pathophysiology and clinical effects of chronic hypoxia. Respir Care. 2000;45(1):39–51.. [discussion: 51–3].PubMedGoogle Scholar
  22. 22.
    Zierer A, Melby SJ, Voeller RK, et al. Significance of neurologic complications in the modern era of cardiac transplantation. Ann Thorac Surg. 2007;83(5):1684–90.CrossRefGoogle Scholar
  23. 23.
    Acampa M, Lazzerini PE, Guideri F, et al. Ischemic stroke after heart transplantation. J Stroke. 2016;18(2):157–68.CrossRefGoogle Scholar
  24. 24.
    Wijdicks EF, Campeau N, Sundt T. Reversible unilateral brain edema presenting with major neurologic deficit after valve repair. Ann Thorac Surg. 2008;86(2):634–7.CrossRefGoogle Scholar
  25. 25.
    Potluri K, Holt D, Hou S. Neurologic complications in renal transplantation. Handb Clin Neurol. 2014;121:1245–55.CrossRefGoogle Scholar
  26. 26.
    Lentine KL, Rocca Rey LA, Kollis S, et al. Variations in the risk for cerebrovascular events after kidney transplant compared with experience on the waiting list and after graft failure. Clin J Am Soc Nephrol. 2008;3:1090–101.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of NeurologyMayo ClinicJacksonvilleUSA
  2. 2.Department of Critical Care Medicine, Neurology, and NeurosurgeryMayo ClinicJacksonvilleUSA

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