Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study
Abstract Background 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, clinic...
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BMC
2025-05-01
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| Online Access: | https://doi.org/10.1186/s12879-025-11039-6 |
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| author | Xingsong Qin Yinsen Song Junjie Ding Xinglei Qin Kun Chen Hongyu Wang |
| author_facet | Xingsong Qin Yinsen Song Junjie Ding Xinglei Qin Kun Chen Hongyu Wang |
| author_sort | Xingsong Qin |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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). Results 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. Conclusions 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. |
| format | Article |
| id | doaj-art-b7028d045bf74b28a4e7b4b6f2d5e4bf |
| institution | DOAJ |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-b7028d045bf74b28a4e7b4b6f2d5e4bf2025-08-20T02:55:21ZengBMCBMC Infectious Diseases1471-23342025-05-0125111410.1186/s12879-025-11039-6Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational studyXingsong Qin0Yinsen Song1Junjie Ding2Xinglei Qin3Kun Chen4Hongyu Wang5Organ Transplant Center, Zhengzhou People’s Hospital/ the Fifth Clinical Medical College of Henan University of Chinese Medicine, ZhengzhouOrgan Transplant Center, Zhengzhou People’s Hospital/ the Fifth Clinical Medical College of Henan University of Chinese Medicine, ZhengzhouOrgan Transplant Center, Zhengzhou People’s Hospital/ the Fifth Clinical Medical College of Henan University of Chinese Medicine, ZhengzhouOrgan Transplant Center, Henan Provincial People’s Hospital/ People’s Hospital of Zhengzhou University, ZhengzhouOrgan Transplant CenterThe 7Th People’s Hospital of Zhengzhou, Zhengzhou, Organ Transplant Center, Zhengzhou People’s Hospital/ the Fifth Clinical Medical College of Henan University of Chinese Medicine, ZhengzhouAbstract Background 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. Methods 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). Results 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. Conclusions 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.https://doi.org/10.1186/s12879-025-11039-6Central nervous system infectionsKidney transplantEpidemiologyPathogenic spectrumPrognosis |
| spellingShingle | Xingsong Qin Yinsen Song Junjie Ding Xinglei Qin Kun Chen Hongyu Wang Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study BMC Infectious Diseases Central nervous system infections Kidney transplant Epidemiology Pathogenic spectrum Prognosis |
| title | Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study |
| title_full | Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study |
| title_fullStr | Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study |
| title_full_unstemmed | Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study |
| title_short | Symptomatic central nervous system infections in kidney transplant recipients: a 20-years multicenter observational study |
| title_sort | symptomatic central nervous system infections in kidney transplant recipients a 20 years multicenter observational study |
| topic | Central nervous system infections Kidney transplant Epidemiology Pathogenic spectrum Prognosis |
| url | https://doi.org/10.1186/s12879-025-11039-6 |
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