Assessment of Central Nervous System Infections in Liver and Kidney Transplantation: Insights from a Transplant Cohort

Abstract

Background: Liver and kidney transplant recipients are vulnerable to various infections, particularly central nervous system (CNS) infections, due to immune system suppression. Timely diagnosis of these infections is crucial to reduce mortality rates. Objectives: The present study aimed to investigate the clinical, laboratory, and radiological manifestations of CNS infections in liver and kidney transplant patients admitted to three hospitals in Mashhad, Iran. Methods: A retrospective cross-sectional analysis was conducted using data from liver and kidney transplant patients during 2018 - 2022. Patients diagnosed with CNS infection through clinical examination, lumbar puncture, computed tomography (CT), or magnetic resonance imaging (MRI) were included. Results: Among the transplant recipients, 11 cases of CNS infection were identified (males: Sixty-three percent). Of the males, 36.4% received kidney transplants, 27.3% received liver transplants, and 18.2% experienced transplant rejection. Among the females, 36.4% received kidney transplants, and 18.2% had transplant rejection. Post-transplantation, 18% experienced early infection, while 82% developed late infection. The identified pathogens causing CNS infection included: Herpes simplex virus (18.18%), Aspergillus, Mycobacterium tuberculosis, Cytomegalovirus, Nocardia, toxoplasmosis, Epstein-Barr virus (9.09% for each), and unidentified (27.27%) of cases. The associations of prednisolone, tacrolimus, azathioprine, mycophenolate mofetil, cyclosporine, and sirolimus with infections were indicated. Conclusions: Infections pose a significant risk to transplant recipients, including CNS infections that can have severe clinical manifestations. Close monitoring is necessary for patients with specific risk factors, such as chronic pulmonary contamination, unresponsive fever, high-dose corticosteroid therapy, and frequent transplant rejection. Vigilance and careful examination for even minor neurological signs are vital due to the impact of immunosuppressive drugs on infection presentations.