Ostman Cecilia, Chacko Bobby
School of Rural Medicine, University of New England, Armidale, NSW, Australia.
Nephrology and Transplantation Unit, John Hunter Hospital, Newcastle, NSW, Australia.
Transpl Infect Dis. 2019 Feb;21(1):e13021. doi: 10.1111/tid.13021. Epub 2018 Nov 28.
Guillain-Barré syndrome (GBS) is a common ascending polyneuropathy in adults. It is often associated with preceding viral or diarrhoeal illness with cytomegalovirus (CMV), Epstein-Barr virus (EBV), or Campylobacter jejuni. Solid organ transplant recipients are more susceptible to opportunistic infections with CMV than the general population as a result of immunosuppressive therapies to prevent graft rejection. However, reports of GBS are rare in this population.
To systematically review cases of GBS in renal transplant patients to evaluate causative pathogens or triggers, management and associated morbidity and mortality.
We conducted a systematic search of the MEDLINE database uncovering 17 cases of GBS in renal transplant patients in the literature. The majority of cases were in males (81%) and patients who received deceased donor renal transplants (87%). The mean age was 44.7 years (SD 13). The time between transplant and onset of symptoms ranged from 2 days to 10 years (Mean = 720 days). GBS was commonly associated with antecedent viral (CMV 12; EBV 1) or diarrhoeal (2) illness while two cases were attributed to calcineurin inhibitor use. All patients recovered fully or partially after treatment with anti-viral or anti-bacterial agents, immunoglobulins, and/or plasma exchange.
Cytomegalovirus is the most common trigger for GBS in the post-renal transplant setting. Other triggers include campylobacter jejuni and calcineurin inhibitors. GBS should be considered in transplant patients presenting with weakness or paralysis in order to institute timely management.
吉兰 - 巴雷综合征（GBS）是成人常见的上行性多发性神经病。它常与先前的病毒感染或腹泻性疾病相关，病原体包括巨细胞病毒（CMV）、EB病毒（EBV）或空肠弯曲菌。由于预防移植排斥的免疫抑制治疗，实体器官移植受者比普通人群更容易发生CMV机会性感染。然而，该人群中GBS的报道很少。
系统回顾肾移植患者中GBS的病例，以评估致病病原体或触发因素、管理以及相关的发病率和死亡率。
我们对MEDLINE数据库进行了系统检索，发现文献中有17例肾移植患者发生GBS。大多数病例为男性（81%），且接受的是 deceased donor 肾移植（87%）。平均年龄为44.7岁（标准差13）。移植与症状出现之间的时间间隔从2天到10年不等（平均 = 720天）。GBS通常与先前的病毒感染（CMV 12例；EBV 1例）或腹泻性疾病（2例）相关，而有2例归因于使用钙调神经磷酸酶抑制剂。所有患者在接受抗病毒或抗菌药物、免疫球蛋白和/或血浆置换治疗后均完全或部分康复。
在肾移植后环境中，巨细胞病毒是GBS最常见的触发因素。其他触发因素包括空肠弯曲菌和钙调神经磷酸酶抑制剂。对于出现无力或麻痹的移植患者，应考虑GBS以便及时进行管理。
