Immunosuppression-Related Early Neurological Complications After Kidney Transplantation
Özet
Neurological complications after kidney transplantation may appear early in the postoperative period and are frequently related to immunosuppressive treatment, metabolic vulnerability, infection, vascular instability, or drug interactions. Among immunosuppression-related disorders, calcineurin inhibitor (CNI) neurotoxicity is the most clinically relevant entity. Tacrolimus and cyclosporine may cause a broad neurological spectrum ranging from tremor, headache, insomnia, paresthesia, and mild cognitive symptoms to encephalopathy, seizures, posterior reversible encephalopathy syndrome (PRES), and, rarely, coma or focal neurological deficits. The presentation may be subtle because fever, leukocytosis, and inflammatory responses can be blunted in immunosuppressed recipients. Early recognition is essential because neurological toxicity may be reversible when precipitating factors are corrected and immunosuppressive therapy is appropriately adjusted. Mechanistic target of rapamycin (mTOR) inhibitors and corticosteroids may also contribute to neurological and psychiatric symptoms, either directly or through metabolic, vascular, and pharmacokinetic mechanisms. Acute delirium and metabolic encephalopathy require a structured differential diagnosis including hypoxia, dysglycemia, electrolyte disturbances, renal or hepatic dysfunction, infection, hypertensive emergency, and medication toxicity. Seizures and status epilepticus in kidney transplant recipients demand rapid standard treatment while considering renal function, dialysis, interactions with immunosuppressants, and avoidance of enzyme-inducing antiseizure medications whenever possible. This chapter summarizes the clinical spectrum, diagnostic approach, and practical management of immunosuppression-related early neurological complications after kidney transplantation, with emphasis on calcineurin inhibitor toxicity, delirium, metabolic encephalopathy, seizures, and status epilepticus.
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