Clinical Analysis Of Central Nervous System Complications After Kidney Transplantation

BackgroundCentral nervous system complications(CNSCs),including epilepsy,infectionrelated encephalopathy,cerebrovascular disease,brain tumors,and psychiatric symptoms,have a high incidence in kidney transplant recipients due to predisposing factors such as low immune status,immunosuppressive drug neurotoxicity,multiple underlying diseases,and poor vascular foundation.This study retrospectively analyzed the incidence of CNSCs in single-center kidney transplant recipients,summarized their incidence,clinical features and prognosis,and explored the risk factors for the incidence and death of CNSCs,aiming to provide reference for clinical diagnosis and treatment and prevention.MethodsAll follow-up data of patients who underwent allogeneic kidney transplantation at Nanfang Hospital of Southern Medical University between January 2013 and June 2020 were collected.A total of 595 patients were enrolled,and the clinical data collected included basic demographic data,age at transplantation,history of various chronic diseases before surgery,type of primary kidney disease,postoperative antirejection treatment drug regimen,whether there was delayed recovery of graft function(DGF)after surgery,whether acute rejection occurred after surgery,and detailed course of CNSCs,including:specific types of complications,time of onset,clinical symptoms,laboratory and imaging examinations,diagnosis and treatment process and prognosis.ResultsBy the end of the follow-up,a total of 73 recipients had CNSCs,with a median follow-up time of 227(148.1-312)weeks,and the cumulative incidence rate was 12.27%.The median age of onset of CNSCs in kidney transplant recipients was 45(3553)years,and the median time of onset was 181(61-546)days after transplantation,of which 67 survived and 6 died.Organic CNSCs accounted for about 26.03%,non-organic CNSCs accounted for about 73.97%,the most common organic CNSCs were cerebrovascular diseases(19.18%),and the most common non-organic CNSC were psychiatric symptoms(67.12%).There were significant differences in age distribution,incidence and time of onset of DGF between different types of CNSCs during transplantation(P<0.05).Univariate analysis showed that the prevalence of diabetes(24.66%vs 14.94%)in the CNSCs group and the CNSCs group was statistically significant.There were significant differences in the incidence of CNSCs(11.61%vs 33.33%)and the prevalence of diabetes mellitus(15.42%vs 38.89%)between the survivor group and the death group(P<0.05).The prognosis of different types of CNSCs was very different,and the survival rates of recipients with infection-related encephalopathy and cerebrovascular disease and non-CNSCs were statistically different,while there was no significant difference in the survival rates of other types of CNSCs and non-CNSCs.COX multivariate regression showed that diabetes and CNSCS were independent risk factors for death,and the risk of death in patients with CNSCS was 3.207 times that of nonCNSC recipients(95%CI:1.170,8.789,P=0.023),and the risk of death in patients with diabetes was 3.016 times that of patients without diabetes(95%CI:1.060,8.583,P=0.039).ConclusionsThe occurrence of CNSCs in kidney transplant recipients was more common,and the cumulative incidence rate in 7 years reached 12.27%.There were significant differences in the age distribution,incidence of DGF and incidence of onset of different types of CNSCs.Diabetes mellitus is a risk factor for the development of CNSCs in kidney transplant recipients,and the occurrence of CNSCs and diabetes are independent risk factors for poor prognosis of recipients.Accurate identification of people at high risk of CNSCs and corresponding preventive measures are expected to reduce the incidence of CNSCs.Early diagnosis and individualized treatment of CNSCs are key to reducing mortality from CNSCs,improving long-term outcomes for transplant recipients,and improving quality of life.