Neuropathologic findings of the central nervous system in patients with transplantation

Hippokratia 1997, 1(4):189-199

NA. Flaris, AD. Konstantinidou


Neurological complications resulting in considerable morbidity and mortality are still frequently seen in transplant patients, despite the gradually prolonged survival rate, improved transplantation techniques and finer control of transplant rejection. Lesions in the central nervous system of 38 transplant patients were studied histopathologically. 33 patients (17 women and 16 men, mean age 32,3 years) underwent autopsy with neuropathologic examination of the CNS. Lesions of the CNS were seen in 21 of 33 of them (63%) and they were the cause of death of the patient in 9 of the 33 (27%). 14 of 33 (42%) showed cerebrovascular lesions and 6 of 33 (18%) infections of the CNS. Encephalitis was most commonly seen histologically in patients with infection. 5 patients (3 men and 2 women, mean age 27,4 years) developed focal lesions of the CNS and underwent brain biopsy. Each of them had different diagnoses. Leukoence-phalopathy was noted in 3 patients (2 with autopsy and 1 with biopsy). Two of these patients had received a bone marrow transplant and their lesions were multifocal, perivascular in location, accompanied by mild perivascular inflammation with no other histologic findings of encephalitis and could probably be attributed to graft vs. host disease. From the aforementioned data, it is evident that transplant patients can present with a wide spectrum of CNS lesions, which have complex pathogenesis. Cerebrovascular events and infections are the complications most commonly seen.