Qin Xingsong, Song Yinsen, Ding Junjie, Qin Xinglei, Chen Kun, Wang Hongyu
Organ Transplant Center, Zhengzhou People's Hospital/ the Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China. No. 33, Huanghe Road, Zhengzhou, Henan, 450003, People's Republic of China.
Organ Transplant Center, Henan Provincial People's Hospital/ People's Hospital of Zhengzhou University, Zhengzhou, No.7, Weiwu Road, Zhengzhou, Henan, 450003, People's Republic of China.
BMC Infect Dis. 2025 May 1;25(1):641. doi: 10.1186/s12879-025-11039-6.
Central nervous system (CNS) infections in kidney transplant recipients (KTRs) remain poorly characterized, with current evidence largely derived from isolated case reports over the past two decades. This multicenter study aims to systematically delineate the epidemiology, clinical profiles, and outcomes of CNS infections in a large KTR cohort.
We conducted a retrospective analysis of 3,602 KTRs across three transplant centers in China (May 2004-July 2024). CNS infections were defined by: 1) neurological symptoms/signs, and 2) microbiological confirmation via cerebrospinal fluid (CSF) analysis, including metagenomic next-generation sequencing (mNGS) and routine microbiologic testing (bacterial and fungal cultures).
CNS infections were diagnosed in 0.53% of KTRs (19/3602), with symptom onset occurring 2-121 months post-transplantation. Etiologies included bacterial (47%, 9/19), viral (32%, 6/19), and fungal (21%, 4/19) pathogens. Notably, 79% of cases (15/19) were exclusively identified by mNGS, whereas conventional cultures failed detection. Presenting symptoms included headache (79%) and altered mental status (42%). Mortality reached 42% (8/19) within 9-22 days of diagnosis; among survivors, 73% (8/11) exhibited neurological sequelae.
CNS infections in KTRs are rare but characterized by rapid progression and high fatality rate. While the risk of CNS infections persists throughout the post-transplant period, 1-6 months after transplantation is a higher-incidence period of CNS infections. KTRs with neurological symptoms (particularly headache and elevated CSF pressure) should undergo CSF mNGS which is critical in diagnosing such infections.
肾移植受者（KTRs）的中枢神经系统（CNS）感染特征仍不明确，目前的证据主要来自过去二十年的个别病例报告。这项多中心研究旨在系统地描述大型KTR队列中CNS感染的流行病学、临床特征和结局。
我们对中国三个移植中心的3602例KTRs进行了回顾性分析（2004年5月至2024年7月）。CNS感染的定义为：1）神经系统症状/体征，以及2）通过脑脊液（CSF）分析进行微生物学确诊，包括宏基因组下一代测序（mNGS）和常规微生物检测（细菌和真菌培养）。
0.53%的KTRs（19/3602）被诊断为CNS感染，症状发作发生在移植后2至121个月。病因包括细菌（47%，9/19）、病毒（32%，6/19）和真菌（21%，4/19）病原体。值得注意的是，79%的病例（15/19）仅通过mNGS确诊，而传统培养未能检测到。出现的症状包括头痛（79%）和精神状态改变（42%）。诊断后9至22天内死亡率达到42%（8/19）；在幸存者中,73%（8/11）有神经后遗症。
KTRs中的CNS感染很少见，但进展迅速且死亡率高。虽然CNS感染风险在移植后整个时期持续存在，但移植后1至6个月是CNS感染的高发期。有神经系统症状（特别是头痛和脑脊液压力升高）的KTRs应进行脑脊液mNGS检测，这对诊断此类感染至关重要。
