Medium And Long-term Neurological Complications After Kidney Transplantation
Neurological complications after renal transplantation
represent an important source of morbidity and may substantially affect
long-term functional status, treatment adherence, quality of life, and graft
outcomes. Although these complications may occur at any time after
transplantation, medium- and long-term neurological manifestations require
particular attention because they are often related to chronic
immunosuppression, opportunistic infections, vascular risk factors, metabolic
disturbances, and drug-related neurotoxicity. This chapter reviews the major
neurological complications encountered after the first month following renal
transplantation, including central nervous system infections, posttransplant
lymphoproliferative disease with CNS involvement, cerebrovascular disease,
chronic cognitive impairment, peripheral neuropathy, and myopathy. A practical
time-based framework is used, defining the medium term as 1 to 6 months and the
long term as the period beyond 6 months after transplantation. Opportunistic
and reactivation infections such as cryptococcal meningitis, progressive
multifocal leukoencephalopathy, cytomegalovirus infection, cerebral
aspergillosis, and toxoplasmosis are discussed with emphasis on clinical
presentation, diagnostic workup, neuroimaging findings, antimicrobial therapy,
and immunosuppression management. Central nervous system posttransplant
lymphoproliferative disease is addressed as a rare but serious late
complication that requires EBV assessment, systemic staging, and histopathological
confirmation. The chapter also highlights the increased burden of
cerebrovascular disease and cognitive impairment in renal transplant
recipients, together with preventive strategies, cognitive screening, and
rehabilitation. Peripheral nervous system and muscle complications, including
calcineurin inhibitor-related neuropathy, tacrolimus-associated chronic
inflammatory demyelinating polyradiculoneuropathy, persistent uremic
neuropathy, diabetic neuropathy, and steroid myopathy, are reviewed with emphasis
on electrophysiological evaluation and multidisciplinary management. Overall,
early recognition, careful adjustment of immunosuppressive therapy, targeted
diagnostic testing, and coordinated care among nephrology, neurology,
infectious diseases, and rehabilitation teams are essential to reduce
neurological morbidity in renal transplant recipients.
Bu kitabın bölümleri bulunmamaktadır.
Atıf Sayısı :
