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Central Nervous System Infections in Pediatric Solid Organ Transplant Recipients

Amna AlSaihati1, Kathleen E Hosek2, Cristina Otero3

  • 1Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.

Pediatric Transplantation
|August 17, 2026
PubMed

Insights

Central nervous system (CNS) infections are rare in pediatric solid organ transplant (SOT) recipients but carry a high mortality risk. Early recognition of non-specific symptoms is crucial for improving outcomes in these vulnerable patients.

Area of Science:

  • Pediatric transplantation
  • Infectious diseases
  • Immunocompromised hosts

Background:

  • Solid organ transplant (SOT) recipients have an elevated risk of central nervous system (CNS) infections due to immunosuppression.
  • While adult SOT CNS infection incidence is known (0.4%-10%), it is not well-defined in pediatric populations.

Purpose of the Study:

  • To determine the incidence, clinical presentation, and outcomes of CNS infections in pediatric SOT recipients.
  • To inform clinical awareness and management strategies for CNS infections in this population.

Main Methods:

  • A single-center retrospective cohort study was conducted.
  • Included 1628 first-time SOT recipients aged 21 years or younger between 2003 and 2023.

Main Results:

  • The incidence of CNS infection was 2.3 per 1000 patient-years, identified in 23 patients.
  • Bacterial and fungal infections each accounted for 35% of cases; symptoms were often non-specific (fever, altered mental status).
  • CNS infection was associated with significantly higher all-cause mortality (39%) compared to those without CNS infection (16%).

Conclusions:

  • CNS infections are infrequent but serious complications in pediatric SOT recipients.
  • High mortality underscores the need for heightened clinical suspicion and prompt diagnosis.
  • Non-specific presentations necessitate vigilance for CNS infections in this immunocompromised group.
Abstract

Keywords:
CNS infectionsheart transplantkidney transplantliver transplantlung transplantpost‐transplant complications

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