Neurological complications following renal transplantation in infants and children: A retrospective single centre study

Introduction: Following renal transplantation in infants and children, neurological complications including seizures, stroke, intracranial haemorrhage, headache, and CNS infection have been described. We aimed to investigate frequency and quality of neurological complications and the relation to risk factors in our patients.

Methods: We retrospectively reviewed clinical data of 261 renal transplantations performed in 248 infants and children in our department between January 1996 and December 2007. Charts of 260 transplantations in 247 patients (159m, 88 f, mean age 9.5 y (0.56–17.8)) could be analyzed.

Results: 13/247 patients had an underlying syndrome or disorder also affecting the nervous system. Additionally, 50/247 patients suffered from different pre-existing neurological co-morbidities. After transplantation, 238/247 patients survived and were followed up for a mean of 13.5 y (confidence interval 13.2–13.8). Overall, neurological complications occurred following 22.7% (59/260) of transplantations in 23.5% (58/247) of patients (37m, 21 f). Seizures were the most frequently observed complications following 27/260 transplantations (11 focal, 7 generalized, 1 both focal and generalized and 8 unclassified). 20/58 patients suffered from headaches, 6/58 had CNS infections, 3/58 cerebral oedema, 2/58 intracranial haemorrhages, 1/58 ischemic stroke, 1/58 multiple ischemic strokes, and 1/58 peripheral facial paresis. Cranial MRI was performed in 25/58 patients with pathological results in 14/25. Neurological complications occurred more frequently following transplantations both in children with an underlying syndrome or disorder also affecting the nervous system (8/16) and children with other pre-existing neurological co-morbidities (15/54) compared to children without pre-existing neurological disease (36/190, p=0.013). In 4 children, the neurological complications were lethal (meningitis in 2, intracranial haemorrhage in 2). If a neurological complication occurred, mortality was significantly higher (p<0.01).

Conclusion: In our retrospective observation, neurological complications occurred following 22.7% of renal transplantations in infants. They significantly contributed to post transplant morbidity and mortality. Presence of an underlying syndrome or disorder also affecting the nervous system as well as other pre-existing neurological co-morbidities was a risk factor.