Central Nervous System Infections in Pediatric Solid Organ Transplant Recipients

Solid organ transplant (SOT) recipients face an increased risk of central nervous system (CNS) infections due to immunosuppression. The incidence of CNS infections in adult SOT recipients ranges from 0.4% to 10%, while it remains unknown in pediatric SOT recipients. Herein, we describe the incidence, clinical presentation, and outcomes of CNS infections in pediatric SOT recipients.

We conducted a single-center retrospective cohort study that included 1628 first-time SOT recipients ≤ 21 years of age from 2003 to 2023.

We identified 23 patients with CNS infection representing an incidence of 2.3 per 1000 patient-years. They occurred in 8/400 (2%) heart; 7/570 (1.2%) liver; 5/220 (2.3%) lung; 2/400 (0.5%) kidney, and 1/38 (2.6%) multi-organ transplant recipients. Documented symptoms included fever in 15/23 (65%), altered mental status in 7/23 (30%), nausea and emesis in 6/23 (26%), and headache in 6/23 (26%). Neuroimaging was performed in 15/23 (65%) patients with CNS infection; 10/15 (67%) had abnormal findings. Bacterial and fungal infections predominated, each accounting for 8/23 (35%) cases, followed by viral infections in 7/23 (30%) cases. Among patients with CNS infection, all-cause mortality was observed in 9/23 (39%), while it was 263/1605 (16%) in those without a CNS infection (p < 0.01).

CNS infections in SOT recipients are rare and presentation can be non-specific, though associated with a high mortality. These findings highlight the importance of maintaining clinical awareness of CNS infection in SOT recipients.