Guillain-Barré syndrome post renal transplant: A systematic review

Abstract

Background: Guillain-Barré syndrome (GBS) is a common ascending polyneuropathy in adults. It is often associated with preceding viral or diarrhoeal illness with cytomegalovirus (CMV), Epstein-Barr virus (EBV), or Campylobacter jejuni. Solid organ transplant recipients are more susceptible to opportunistic infections with CMV than the general population as a result of immunosuppressive therapies to prevent graft rejection. However, reports of GBS are rare in this population.

Objective: To systematically review cases of GBS in renal transplant patients to evaluate causative pathogens or triggers, management and associated morbidity and mortality.

Methods and results: We conducted a systematic search of the MEDLINE database uncovering 17 cases of GBS in renal transplant patients in the literature. The majority of cases were in males (81%) and patients who received deceased donor renal transplants (87%). The mean age was 44.7 years (SD 13). The time between transplant and onset of symptoms ranged from 2 days to 10 years (Mean = 720 days). GBS was commonly associated with antecedent viral (CMV 12; EBV 1) or diarrhoeal (2) illness while two cases were attributed to calcineurin inhibitor use. All patients recovered fully or partially after treatment with anti-viral or anti-bacterial agents, immunoglobulins, and/or plasma exchange.

Conclusion: Cytomegalovirus is the most common trigger for GBS in the post-renal transplant setting. Other triggers include campylobacter jejuni and calcineurin inhibitors. GBS should be considered in transplant patients presenting with weakness or paralysis in order to institute timely management.

Keywords: Guillain-Barré syndrome; cytomegalovirus; immunoglobulin therapy; plasma exchange; renal transplant.