Central Nervous System Infections in Pediatric Solid Organ Transplant Recipients.

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