IN a comprehensive multicenter study spanning 20 years, researchers have identified central nervous system (CNS) infections in kidney transplant recipients (KTRs) as a rare but devastating complication, with high mortality and persistent neurological effects. The study, based on 3,602 patients across three transplant centers in China, reveals that CNS infections affected just 0.53% of KTRs—but with a fatality rate of 42% and long-term neurological sequelae in nearly three-quarters of survivors, the clinical impact is severe.
The retrospective analysis, conducted from May 2004 to July 2024, defined CNS infections by the presence of neurological symptoms alongside microbiological confirmation from cerebrospinal fluid (CSF) analysis. The use of metagenomic next-generation sequencing (mNGS) proved critical, identifying 79% of infections undetected by traditional culture methods.
Among the 19 identified cases, bacterial pathogens were most common (47%), followed by viral (32%) and fungal (21%) causes. Symptoms typically emerged anywhere from 2 to 121 months after transplantation, though the highest incidence was noted between 1 to 6 months post-surgery. Common presenting symptoms included headache in 79% and altered mental status in 42% of patients. Elevated CSF pressure was also a notable clinical marker.
Despite the rarity of these infections, their rapid onset and severe outcomes underscore the importance of prompt diagnosis. The findings advocate for early CSF mNGS testing in KTRs with neurological symptoms to enable timely and accurate identification of pathogens that may otherwise evade conventional testing.
This study provides the most robust clinical dataset to date on CNS infections in kidney transplant recipients and highlights both the diagnostic value of mNGS and the critical need for vigilance during the early post-transplantation period.
Reference:
Zhou Y, Li X, Fu W, et al. Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study. Am J Transplant. 2024;24:1–11.
