Pruitt Amy A, Graus Francesc, Rosenfeld Myrna R
Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Neurohospitalist. 2013 Jul;3(3):152-66. doi: 10.1177/1941874412466090.
Solid organ transplantation (SOT) is the preferred treatment for an expanding range of conditions whose successful therapy has produced a growing population of chronically immunosuppressed patients with potential neurological problems. While the spectrum of neurological complications varies with the type of organ transplanted, the indication for the procedure, and the intensity of long-term required immunosuppression, major neurological complications occur with all SOT types. The second part of this 2-part article on transplantation neurology reviews central and peripheral nervous system problems associated with SOT with clinical and neuroimaging examples from the authors' institutional experience. Particular emphasis is given to conditions acquired from the donated organ or tissue, problems specific to types of organs transplanted and drug therapy-related complications likely to be encountered by hospitalists. Neurologically important syndromes such as immune reconstitution inflammatory syndrome (IRIS), posterior reversible encephalopathy syndrome (PRES), and posttransplantation lymphoproliferative disorder (PTLD) are readdressed in the context of SOT.
实体器官移植(SOT)是治疗越来越多疾病的首选方法,这些疾病的成功治疗使得慢性免疫抑制患者群体不断增加,他们存在潜在的神经问题。虽然神经并发症的范围因移植器官的类型、手术指征以及长期所需免疫抑制的强度而异,但所有类型的SOT都会出现主要的神经并发症。这篇关于移植神经学的分两部分的文章的第二部分,结合作者所在机构的临床和神经影像学实例,回顾了与SOT相关的中枢和周围神经系统问题。特别强调了从捐赠器官或组织获得的疾病、特定移植器官类型特有的问题以及住院医师可能遇到的药物治疗相关并发症。在SOT的背景下,重新探讨了免疫重建炎症综合征(IRIS)、后部可逆性脑病综合征(PRES)和移植后淋巴细胞增生性疾病(PTLD)等具有重要神经学意义的综合征。