Brain abscess following solid organ transplantation: A 21-year retrospective study

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Neurology

Background:

• Brain abscesses are a severe complication in solid organ transplant (SOT) recipients, associated with high rates of illness and death.
• Understanding the specific challenges of brain abscesses in SOT patients is crucial for improving outcomes.

Purpose of the Study:

• To investigate the causes, clinical features, diagnostic methods, treatments, and outcomes of brain abscesses in SOT recipients.
• To identify the most common pathogens and risk factors associated with brain abscesses post-transplantation.

Main Methods:

• A retrospective study was conducted involving adult SOT recipients diagnosed with brain abscesses between January 2000 and June 2021.
• Data were collected from three major transplant centers, analyzing patient demographics, transplant types, pathogens, time to diagnosis, and treatment approaches.

Main Results:

• Nocardia (61.5%) and fungi (30.7%) were the predominant pathogens identified in 39 SOT patients with brain abscesses.
• Kidney transplant recipients constituted the majority (59%). Median time to diagnosis was 1.3 years post-SOT, with fungal abscesses often diagnosed within the first year.
• Mortality was significant, with 28.2% of patients dying from brain abscesses and an overall all-cause mortality of 43.6%.

Conclusions:

• Brain abscess is an infrequent but serious infectious complication following SOT.
• Nocardia and fungal infections are responsible for the majority of brain abscesses in this population.
• Fungal brain abscesses are associated with a particularly poor prognosis, highlighting the need for timely diagnosis and targeted treatment.