Intestinal and multivisceral transplantation has evolved from an experimental procedure to the treatment of choice for patients with irreversible intestinal failure and serious complications related to long-term parenteral nutrition. Increased numbers of transplant recipients and improved survival rates have led to an increased prevalence of this patient population in intensive care units. Management of intestinal and multivisceral transplant recipients is uniquely challenging because of complications arising from the high incidence of transplant rejection and its treatment. Long-term comorbidities, such as diabetes, hypertension, chronic kidney failure, and neurological sequelae, also develop in this patient population as survival improves. This article is intended for intensivists who provide care to critically ill recipients of intestinal and multivisceral transplants. As perioperative care of intestinal/multivisceral transplant recipients has been described elsewhere, this review focuses on common nonsurgical complications with which one should be familiar in order to provide optimal care. The article is both a review of the current literature on multivisceral and isolated intestinal transplantation as well as a reflection of our own experience at the University of Miami.
HauserGJKaufmanSSMatsumotoCSFishbeinTM. Pediatric intestinal and multivisceral transplantation: a new challenge for the pediatric intensivist. Intensive Care Med. 2008;34(9):1570–1579.
2.
McLaughlinGEGelmanBGKuluzJW. Pediatric intensive care unit utilization and outcome in a solid organ transplant population. Pediatr Crit Care Med. 2005;6(1):103.
3.
KatoTTzakisAGSelvaggiG. Intestinal and multivisceral transplantation in children. Ann Surg. 2006;243(6):756–764.
4.
ViannaRMMangusRSTextorAJ. Current status of small bowel and multivisceral transplantation. Adv Surg. 2008;42:129–150.
5.
ZivkovicSAEidelmanBHBondGECostaGAbu-Elmagd. The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation. Clin Transplant. 2010;24(2):164–168.
6.
Abu-ElmagdKMCostaGBondGJ. Evolution of the immunosuppressive strategies for the intestinal and multivisceral recipients with special reference to allograft immunity and achievement of partial tolerance. Transpl Int. 2009;22(1):96–109.
7.
PirenneJKawaiM. Intestinal transplantation: evolution in immunosuppression protocols. Curr Opin Organ Transplant. 2009;14(3):250–255.
8.
PascherAKohlerSNeuhausPPratschkeJ. Present status and future perspectives of intestinal transplantation. Transpl Int. 2008;21(5):401–414.
9.
PirenneJKawaiM. Tolerogenic protocol for intestinal transplantation. Transplant Proc. 2006;38(6):1664–1667.
10.
LiXCAlmawiWJevnikarATuckerJZhongRGrantD. Allogeneic lymphocyte proliferation stimulated by small intestine-derived epithelial cells. Transplantation. 1995;60(1):82–89.
11.
KatoTGaynorJJSelvaggiG. Intestinal transplantation in children: a summary of clinical outcomes and prognostic factors in 108 patients from a single center. J Gastrointest Surg. 2005;9(1):75–89.
12.
SelvaggiGGaynorJJMoonJ. Analysis of acute cellular rejection episodes in recipients of primary intestinal transplantation: a single center, 11-year experience. Am J Transplant. 2007;7(5):1249–1257.
13.
NayyarNMazariegosGRanganathanS. Pediatric small bowel transplantation. Semin Pediatr Surg. 2010;19(1):68–77.
14.
NovelliM. Muiesan P, Miele-Vergani G, Dhawan A, Rela M, Heaton ND. Oral absorption of tacrolimus in children with intestinal failure due to short or absent small bowel. Transpl Int. 1999;12(6);463–465.
15.
SanoNNioMShimaokaS. High trough levels of oral FK506 induced by loss of small intestine. Pediatr Transplantat. 2001;5(6):434–438.
16.
SigurdssonL. Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease. Transplantation. 2000;70(2):302–305.
17.
WuGKnabeDAFlynnNE. Synthesis of citrulline from glutamine in pig enterocytes. Biochem J. 1994;299(1):115–121.
18.
CrennPMessingBCynoberL. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr. 2008;27(3):328–339.
19.
GondolesiGGhirardoSRaymondK. The value of plasma citrulline to predict mucosal injury in intestinal allografts. Am J Transplant. 2006;6(11):2786–2790.
20.
RuizPTryphonopoulosPIslandE. Citrulline evaluation in bowel transplantation. Transplant Proc. 2010;42(1):54–56.
21.
DavidAISelvaggiGRuizP. Blood citrulline level is an exclusionary marker for significant acute rejection after intestinal transplantation. Transplantation. 2007;84(9):1077–1081.
22.
AkpinarEVargasJKatoT. Fecal calprotectin level measurements in small bowel allograft monitoring: a pilot study. Transplantation. 2008;85(9):1281–1286.
23.
FoellDWittkowskiHRothJ. Monitoring disease activity by stool analyses: from occult blood to molecular markers of intestinal inflammation and damage. Gut. 2009;58(6):859–868.
24.
AvitzurYGrantD. Intestine transplantation in children: update 2010. Pediatr Clin North Am. 2010;57(2):415–431.
25.
LeeRGNakamuraKTsamandasAC. Pathology of human intestinal transplantation. Gastroenterology. 1996;110(6):1820–1834.
26.
SigurdssonLKocoshisSTodoSPutnamPReyesJ. Severe exfoliative rejection after intestinal transplantation in children. Transplant Proc. 1996;28(5):2783–2784.
27.
MichaelsPJFishbeinMCColvinRB. Humoral rejection of human organ transplants. Springer Semin Immunopathol. 2003;25(2):119–140.
28.
YardBSpruyt-GerritseMClaasF. The clinical significance of allospecific antibodies against endothelial cells detected with an antibody-dependent cellular cytotoxicity assay for vascular rejection and graft loss after renal transplantation. Transplantation. 1993;55(6):1287–1293.
29.
KatoTMizutaniKTerasakiP. Association of emergence of HLA antibody and acute rejection in intestinal transplant recipients: a possible evidence of acute humoral sensitization. Transplant Proc. 2006;38(6):1735–1737.
30.
RuizPGarciaMPappasP. Mucosal vascular alterations in isolated small-bowel allografts: relationship to humoral sensitization. Am J Transplant. 2003;3(1):43–49.
31.
MagilABTinckamK. Monocytes and peritubular capillary C4d deposition in acute renal allograft rejection. Kidney Int. 2003;63(5):1888–1893.
32.
PisaniBAMullenGMMalinowskaK. Plasmapheresis with intravenous immunoglobulin G is effective in patients with elevated panel reactive antibody prior to cardiac transplantation. J Heart Lung Transplant. 1999;18(7):701–706.
33.
LefaucheurCNochyDAndradeJVerineJ. Comparison of combination Plasmapheresis/IVIg/anti-CD20 versus high-dose IVIg in the treatment of antibody-mediated rejection. Am J Transplant. 2009;9(5):1099–1107.
34.
KaposztasZPodderHMauiyyediS. Impact of rituximab therapy for treatment of acute humoral rejection. Clin Transplant. 2009;23(1):63–73.
IslandERGonzalez-PintoIMTsaiHL. Successful treatment with bortezomib of a refractory humoral rejection of the intestine after multivisceral transplantation. Clin Transpl.2009;27(5):465–469.
37.
TakahashiHKatoTDelacruzV. Analysis of acute and chronic rejection in multiple organ allografts from retransplantation and autopsy cases of multivisceral transplantation. Transplantation. 2008;85(11):1610–1616.
38.
MazariegosGVSoltysKBondG. Pediatric intestinal retransplantation: techniques, management, and outcomes. Transplantation. 2008;86(12):1777–1782.
39.
AndresAMSantamaríaMLRamosE. Graft-vs-host disease after small bowel transplantation in children. J Pediatr Surg. 2010;45(2):330–336.
40.
WillenbacherWBasaraNBlauIWFauserAAKiehlMG. Treatment of steroid refractory acute and chronic graft-versus-host disease with daclizumab. Br J Haematol. 2001;112(3):820–823.
41.
BairdKCookeKSchultzKR. Chronic graft-versus-host disease (GVHD) in children. Pediatr Clin North Am. 2010;57(1):297–322.
42.
SrinivasanRChakrabartiSWalshT. Improved survival in steroid-refractory acute graft versus host disease after non-myeloablative allogeneic transplantation using a daclizumab-based strategy with comprehensive infection prophylaxis. Br J Haematol. 2004;124(6):777–786.
43.
YanikGAUbertiJPFerraraJLM. Etanercept for sub-acute lung injury following allogeneic stem cell transplantation. Blood. 2003;102:471a.
44.
BuscaALocatelliFMarmontF. Recombinant human soluble tumor necrosis factor receptor fusion protein as treatment for steroid refractory graft- versus-host disease following allogeneic hematopoietic stem cell transplantation. Am J Hematol. 2007;82(1):45–52.
45.
MessinaCLocatelliFLaninoE. Extracorporeal photochemotherapy for paediatric patients with graft-versus-host disease after haematopoietic stem cell transplantation. Br J Haematol. 2003;122(1):118–127.
46.
BairdKWayneAS. Extracorporeal photo-apheresis for the treatment of steroid-resistant graft versus host disease. Transfus Apher Sci. 2009;41(3):209–216.
47.
RubinRH. Infection in the organ transplant recipient. In: RubinRHYoungLS eds. Clinical Approach to Infection in the Compromised Host. 3rd edNew York, NY: Plenum Publishing; 1994:629–705.
48.
FishmanJARubinRH. Infection in organ-transplant recipients. N Engl J Med. 1998;338(24):1741–1751.
49.
GreenMMichaelsMG. Infections in solid organ transplant recipients. In: LongSSProberCGPickeringLK eds. Principles & Practice of Pediatric Infectious Diseases. 3rd edNew York, NY: Churchill Livingstone; 2008:551–557.
50.
KeoughWLMichaelsMG. Infectious complications in pediatric solid organ transplantation. Pediatr. Clin North Am. 2003;50(6):1451–1469.
51.
FishmanJA. Infection in solid organ transplant recipients. N Engl J Med. 2007;357(25):2601–2614.
52.
RanoAAgustiCJimenezP. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using noninvasive and bronchoscopic procedures. Thorax. 2001;56(5):379–387.
53.
ShorrAFMooresLKEdenfieldWJ. Mechanical ventilation in hematopoietic stem cell transplantation: can we effectively predict outcomes?. Chest. 1999;116(4):1012–1018.
54.
KotloffRMAhyaVNCrawfordSW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2004;170(1):22–48.
RobertsRJ. Sirolimus-induced pneumonitis following liver transplantation. Liver Transpl.2007;13(6):853–856.
57.
ShorrAFSulsaGMGradyNP. Pulmonary infiltrates in the non-HIV infected immunocompromised patient: etiologies, diagnostic strategies and outcomes. Chest. 2004;125(1):260–271.
58.
OosterheertJJvan LoonAMSchuurmanR. Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis. 2005;41(10):1438–1444.
59.
TempletonKEScheltingaSAvan den EedenWC. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis. 2005;41(3):345–351.
60.
LidenPK. Approach to the immunocompromised host with infection in the intensive care unit. Infect Dis Clin N Am. 2009;23(3):535–556.
61.
BarloonJTGalvinJRMoriM. High-resolution ultrafast chest CT in the management of febrile bone marrow transplant patients with normal or nonspecific chest roentgenograms. Chest. 1991;99(4):928–933.
62.
HeusselCPKauczorHUHeusselG. Early detection of pneumonia in febrile neutropenic patients: use of thin-section CT. Am J Roentgenol. 1997;169(5):1347–1353.
63.
Vendryes C3rdMcLaughlinGERomagueraRL. Open lung biopsy in pediatric patients with respiratory failure after abdominal transplantation. Pediatr Transplant. 2005;9(2):197–200.
64.
BaumannHJ. Yield and safety of bedside open lung biopsy in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome. Surgery. 2. 008;143(3):426–433.
65.
LimSYSuhGYChoiJC. Usefulness of open lung biopsy in mechanically ventilated patients with undiagnosed diffuse pulmonary infiltrates: influence of comorbidities and organ dysfunction. Critical Care. 2007;11(4):R93.
66.
WagenerMMYuVL. Bacteremia in transplant recipients: a prospective study of demographics, etiologic agents, risk factors, and outcomes. Am J Infect Control. 1992;20(5):239–247.
67.
BergRD. Bacterial translocation from the gastrointestinal tract. J Med. 1992;23(3-4):217–244.
68.
CicaleseLSileriPGreenM. Bacterial translocation in clinical intestinal transplantation. Transplantation. 2001;71(10):1414–1417.
69.
MorrellMFraserVJKollefMH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49(9):3640–3645.
70.
KollefMHShermanGWardS. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115(2):263–274.
71.
IbrahimEHShermanGWardS. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118(1):146–155.
72.
RiversENguyenBHavstadS. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–1377.
73.
DellingerRPLevyMMCarletJM. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327.
74.
WatsonMJVenickRSKaldasF. Renal function impacts outcomes after intestinal transplantation. Transplantation. 2008;86(1):117–122.
75.
OjoAOHeldPJPortFK. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931–940.
76.
PlatzKPMuellerARBlumhardtG. Nephrotoxicity following orthotopic liver transplantation. A comparison between cyclosporine and FK506. Transplantation. 1994;58(2):170–178.
77.
UenoTKatoTGaynorJ. Renal dysfunction following adult intestinal transplant under tacrolimus-based immunosuppression. Transplant Proc. 2006;38(6):1762–1764.
78.
WyattCMAronsRR. The burden of acute renal failure in nonrenal solid organ transplantation. Transplantation. 2004;78(9):1351–1355.
79.
McLaughlinGEAbitbolCL. Reversal of oliguric tacrolimus nephrotoxicity in children. Nephrol Dial Transplant. 2005;20(7):1471–1475.
80.
BiancofioreGDella RoccaGBindiL. Use of fenoldopam to control renal dysfunction early after liver transplantation. Liver Transpl. 2004;10(8):986–992.
81.
JorkaskyDKAudetPShustermanN. Fenoldopam reverses cyclosporine-induced renal vasoconstriction in kidney transplant recipients. Am J Kidney Dis. 1992;19(6):567–572.
82.
JoannidisM. Continuous renal replacement therapy in sepsis and multisystem organ failure. Semin Dial. 2009;22(2):160–164.
83.
GoldsteinSL. Overview of pediatric renal replacement therapy in acute kidney injury. Semin Dial. 2009;22(2):180–184.
84.
BrophyPDMottesTAKudelkaTL. AN-69 membrane reactions are pH-dependent and preventable. Am J Kidney Dis. 2001;38(1):173–178.
85.
UenoTKatoTGaynorJ. Renal function after pediatric intestinal transplant. Transplant Proc. 2006;38(6):1759–1761.
AndersohnFKonzenCGarbeE. Nonchemotherapy drug-induced agranulocytosis: A systematic review of case reports. Ann Intern Med. 2007;146(9):657–665.
88.
Al-UzriAYorginPDKlingPJ. Anemia in children after transplantation: etiology and the effect of immunosuppressive therapy on erythropoiesis. Pediatr Transplant. 2003;7(4):253–264.
89.
Sanchez-GironFAlvarez-MoraF. Reduction of blood loss from laboratory testing in hospitalized patients using small-volume (pediatric) tubes. Arch Pathol Lab Med. 2008;132(12):1916–1919.
90.
MisraSMooreTBAmentMEBusuttilRWMcdiarmidSV. Red cell aplasia in children on tacrolimus after liver transplantation. Transplantation. 1998;65(4):575–577.
91.
BrumSNolascoFSousaJ. Leukopenia in kidney transplant patients with the association of valganciclovir and mycophenolate mofetil. Transplant Proc. 2008;40(3):752–754.
92.
DanesiRTaccaM. Hematologic toxicity of immunosuppressive treatment. Transplant Proc. 2004;36(3):703–704.
93.
European Mycophenolate Mofetil Cooperative Study Group. MMF in renal transplantation: 3-year results from the placebo-controlled trial. Transplantation. 1999;68(3):391–396.
94.
MacDonald AS. RAPAMUNE Global Study Group. A worldwide phase III, randomized controlled, safety and efficacy study of a sirolimus/cyclosporine regimen for prevention of acute rejection in recipients of primary mismatched renal allografts. Transplantation. 2001;71(2):271–280.
95.
BrownKEAndersonSMYoungNS. Erythrocyte P antigen: Cellular receptor for B19 parvovirus. Science. 1993;262(5130):114–117.
96.
BrolidenK. Parvovirus B 19 infection in pediatric solid organ and bone marrow transplantation. Pediatr Transplantation. 2001;5(5):320–330.
97.
GallinellaGManaresiEVenturoliSGraziGLMusianiMZerbiniM. Occurrence and clinical role of active parvovirus B19 infection in transplant recipients. Eur J Clin Microbiol Infect Dis. 1999;18(11):811–813.
98.
NourBGreenMMichaelsM. Parvovirus B19 infection in pediatric transplant patients. Transplatation. 1993;55:427–430.
99.
ChangFYSinghNGayowskiTMarinoIR. Parvovirus B19 infection in a liver transplant recipient: case report and review in organ transplant recipients. Clin Transpl. 1996;10(3):243–247.
100.
KurtzmanGFrickhofenNKimballJJenkinsDWNienhuisAWYoungNS. Pure red cell aplasia from ten years duration due to persistent parvovirus B19 infection and its cure with immunoglobulin therapy. N Engl J Med. 1989;321(8):519–523.
101.
WongTYHChanPKSLeungCBSzetoCCTamJSLiPKT. Parvovirus B19 infection causing red cell aplasia in renal transplantation on tacrolimus. Am J Kidney Dis. 1999;34(6):1132–1136.
102.
FrohnCJabsWJFrickeLGoergS. Hemolytic anemia after kidney transplantation: case report and differential diagnosis. Ann Hematol. 2002;81(3):158–160.
103.
AinsworthCDCrowtherMATreleavenDEvanovitchDWebertKEBlajchmanMA. Severe hemolytic anemia post-renal transplantation produced by donor anti-D passenger lymphocytes: case report and literature review. Transfus Med Rev. 2009;23(2):155–159.
104.
RamseyG. Red cell antibodies arising from solid organ transplants. Transfusion. 1991;31(1):76–86.
105.
WestKAAndersonDRMcAlisterVC. Alloimmune thrombocytopenia after organ transplantation. N Engl J Med. 1999;341(20):1504–1507.
106.
LacailleFMoesNHugotJPCezardJPGouletORuemmeleFM. Severe dysimmune cytopenia in children treated with tacrolimus after organ transplantation. Am J Transplant. 2006;6(5 pt 1):1072–6.
107.
RemuzziG. HUS and TTP. Variable expression of a single entity. Kidney Int. 1987;32(2):292–308.
108.
RamasubbuKMullickTKooA. Thrombotic microangiopathy and cytomegalovirus in liver transplant recipients: a case-based review. Transp Infect Dis. 2003;5(2):98–103.
109.
TrimarchiHMTruongLDBrennanSGonzalezJMSukiWN. FK506-associated thrombotic microangiopathy: report of two cases and review of the literature. Transplantation. 1999;67(4):539–544.
110.
AllenaU.PreiksaitisbJ. and the AST Infectious Diseases Community of Practice. Epstein-Barr virus and posttransplant lymphoproliferative disorder in solid organ transplant recipients. Am J Transplant. 2009;9(Suppl 4):S87–S96.
111.
DharnidharkaVRTejaniAHHoPL. Post-transplant lymphoproliferative disorder in the United States: young Caucasian males are at highest risk. Am J Transplant. 2002;2(10):993–998.
112.
BuellJFGrossTGWoodleES. Malignancy after transplantation. Transplantation. 2005;80(suppl 2):S254–S264.
113.
GrossTGSavoldoBPunnetA. Posttransplant lymphoproliferative disorder. Pediatr Clin N Am. 2010;57(2):481–503.
114.
OpelzGDanielVNaujokatC. Epidemiology of pretransplant EBV and CMV serostatus in relation to posttransplant non-Hodgkin lylmphoma. Transplantation. 2009;88(8):962–967.
115.
OpelzGDohlerB. Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant. 2004;4(2):222–230.
116.
RoweDTQuLReyesJ. Use of quantitative competitive PCR to measure Epstein-Barr virus genome load in the peripheral blood of pediatric transplant patients with lymphoproliferative disorders. J Clin Microbiol. 1997;35(6):1612–1615.
117.
StevensSJVerschuurenEAPronkI. Frequent monitoring of Epstein-Barr virus DNA load in unfractionated whole blood is essential for early detection of posttransplant lymphoproliferative disease in high-risk patients. Blood. 2001;97(5):1165–1171.
118.
NalesnikMA. The diverse pathology of post-transplant lymphoproliferative disorders: the importance of a standardized approach. Transplant Infect Dis. 2001;3(2):88–96.
119.
HurwitzMDesaiDMCoxKL. Complete immunosuppressive withdrawal as a uniform approach to post-transplant lymphoproliferative disease in pediatric liver transplantation. Pediatr Transplant. 2004;8(3):267–272.
120.
DottiGFiocchiRMottaT. Lymphomas occurring late after solid-organ transplantation: influence of treatment on the clinical outcome. Transplantation. 2002;74(8):1095–1102.
121.
KoffmanBHKennedyASHeymanM. Use of radiation therapy in posttransplant lymphoproliferative disorder (PTLD) after liver transplantation. Int J Cancer. 2000;90(2):104–109.
122.
FreyNV. The management of posttransplant lymphoproliferative disorder. Med Oncol. 2007;24(2):125–136.
123.
MilpiedNVasseurBParquetN. Humanized anti-CD20 monoclonal antibody (Rituximab) in post transplant Blymphoproliferative disorder: a retrospective analysis on 32 patients. Ann Oncol. 2000;11(suppl 1):113–116.
124.
OertelSHVerschuurenEReinkeP. Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transplant. 2005;5(12):2901–2906.
125.
Van EsserJWNiestersHGvan der HoltB. Prevention of Epstein-Barr virus-lymphoproliferative disease by molecular monitoring and preemptive rituximab in high-risk patients after allogeneic stem cell transplantation. Blood. 2002;99(12):4364–4369.
126.
GrossTGBucuvalasJParkJ. Low dose chemotherapy for the treatment of refractory post-transplant lymphoproliferative disease in children. J Clin Oncol. 2005;23(27):6481–6488.
127.
LeblondVDhedinNBruneelMM. Identification of prognostic factors in 61 patients with posttransplantation lymphoproliferative disorders. J Clin Oncol. 2001;19(3):772–778.
128.
TrofeJBuellJFBeebeTM. Analysis of factors that influence survival with post-transplant lymphoproliferative disorder in renal transplant recipients: the Israel Penn International Transplant Tumor Registry experience. Am J Transplant. 2005;5(4 pt 1):775–780.
129.
TheveninDMBakerAKatoTTzakisAFernandezMDowlingM. Neurodevelopmental outcomes of infant multivisceral transplant recipients: a longitudinal study. Transplant Proc. 2006;38(6):1694–1695.
130.
TheveninDMBakerAKatoTTzakisAFernandezMDowlingM. Neurodevelopmental outcomes for children transplanted under the age of 3 years. Transplant Proc. 2006;38(6):1692–1693.
131.
SenzoloMFerronatoCBurraP. Neurologic complications after solid organ transplantation. Transpl Int. 2008;22(3):269–278.
132.
UckanDCetinMYigitkanliI. Life-threatening neurological complications after bone marrow transplantation in children. Bone Marrow Transplant. 2005;35(1):71–76.
133.
GijtenbeekJMvan den BentMJVechtCJ. Cyclosporine neurotoxicity: a review. J Neurol. 1999;246(5):339–346.
134.
BechsteinWO. Neurotoxicity of calcineurin inhibitors: impact and clinical management. Transpl Int. 2000;13(5):313–326.
135.
PalmerBFTotoRD. Systemic neurologic toxicity induced by cyclosporine A in three renal transplant patients. Am J Kidney Dis. 1991;18(1):116–121.
136.
BartynskiWSTanHPBoardmanJF. Posterior reversible encephalopathy syndrome after solid organ transplantation. Am J Neuroradiol. 2008;29(5):924–930.
137.
AdairJCWoodleySLO’ConnellJBCallGKBaringerJR. Aseptic meningitis following cardiac transplantation: clinical characteristics and relationship to immunosuppressive regimen. Neurology. 1991;41(2 pt 1):249–252.
138.
WangFZLindeAHagglundHTestaMLocasciulliALjungmanP. Human herpesvirus 6 DNA in cerebrospinal fluid specimens from allogeneic bone marrow transplant patients: does it have clinical significance?. Clin Infect Dis. 1999;28(3):562–568.
139.
CzartoskiT. Central nervous system infections in transplantation. Curr Treat Options Neurol. 2006;8(3):193–201.
140.
SinghNHusainS. Infections of the central nervous system in transplant recipients. Transpl Infect Dis. 2000;2(3):101–111.
141.
Torre-CisnerosJLopezOLKusneS. CNS aspergillosis in organ transplantation: a clinicopathological study. J Neurol Neurosurg Psychiatry. 1993;56(2):188–193.
142.
Van de BeekDPatelRDalyRCMcGregorCGWijdicksEF. Central nervous system infections in heart transplant recipients. Arch Neurol. 2007;64(12):1715–1720.
PayaCVFungJJNalesnikMA. EBV-induced post-transplant lymphoproliferative disorders. ASTS/ASTP EBV. PTLD Task Force and the Mayo clinic organized international consensus development meeting. Transplantation. 1999;68(10):1517–1525.
