Medium And Long-Term Neurological Complicatıons After Kidney Transplantation
Özet
Neurological complications after renal transplantation represent an important source of morbidity and may substantially affect long-term functional status, treatment adherence, quality of life, and graft outcomes. Although these complications may occur at any time after transplantation, medium- and long-term neurological manifestations require particular attention because they are often related to chronic immunosuppression, opportunistic infections, vascular risk factors, metabolic disturbances, and drug-related neurotoxicity. This chapter reviews the major neurological complications encountered after the first month following renal transplantation, including central nervous system infections, posttransplant lymphoproliferative disease with CNS involvement, cerebrovascular disease, chronic cognitive impairment, peripheral neuropathy, and myopathy. A practical time-based framework is used, defining the medium term as 1 to 6 months and the long term as the period beyond 6 months after transplantation. Opportunistic and reactivation infections such as cryptococcal meningitis, progressive multifocal leukoencephalopathy, cytomegalovirus infection, cerebral aspergillosis, and toxoplasmosis are discussed with emphasis on clinical presentation, diagnostic workup, neuroimaging findings, antimicrobial therapy, and immunosuppression management. Central nervous system posttransplant lymphoproliferative disease is addressed as a rare but serious late complication that requires EBV assessment, systemic staging, and histopathological confirmation. The chapter also highlights the increased burden of cerebrovascular disease and cognitive impairment in renal transplant recipients, together with preventive strategies, cognitive screening, and rehabilitation. Peripheral nervous system and muscle complications, including calcineurin inhibitor-related neuropathy, tacrolimus-associated chronic inflammatory demyelinating polyradiculoneuropathy, persistent uremic neuropathy, diabetic neuropathy, and steroid myopathy, are reviewed with emphasis on electrophysiological evaluation and multidisciplinary management. Overall, early recognition, careful adjustment of immunosuppressive therapy, targeted diagnostic testing, and coordinated care among nephrology, neurology, infectious diseases, and rehabilitation teams are essential to reduce neurological morbidity in renal transplant recipients.
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