Introduction: Major neurological complications can add significant morbidity and mortality to renal transplant and have frequencies ranging from 6 to 30% in all transplant recipients.

Objective: To evaluate the most frequent neurologic syndromes regarding epidemiological and clinical features, specific diagnosis and outcomes in a single kidney transplant center.

Methods: This retrospective cohort study evaluated renal transplant recipients who required hospitalization for neurologic symptoms or who developed neurological symptoms during hospitalization for other reasons, between July 2008 to April 2010.

Results: During this period there were 145 recipients with neurological symptoms requiring specialized interventions. Of them, 45% were male, mean age of 46 years, 57% Caucasian. Comorbidities more frequently associated were hypertension (80%), dyslipidemia (37%) and diabetes (30%). Of the transplants, 96% were kidney transplants and 4% simultaneous kidney-pancreas transplants. Regarding donor source, 38% were from living donors. Mean time from kidney transplant to presentation was 1206 ± 1351 days. Mean estimated creatinine clearance (MDRD) was 44 ml/min at time of diagnosis.

The most frequent neurologic syndromes were: focal neurologic deficit (20%), acute confusion (16%), seizures (15%) and headache (13%). The most frequent specific diagnosis was cerebral vascular accident for focal neurologic deficit syndrome (52%), delirium for acute confusion (48%), epilepsy for seizures (84%) and central nervous system infection for headache (42%).

In-hospital mortality rate was 12%. The neurologic syndrome mostly associated with mortality was acute confusion (mortality rate 41%). The specific diagnosis associated with the higher mortality rate was central nervous system infection (31%).

Conclusion: Neurologic syndromes and specific diagnosis are associated with high mortality in kidney transplant recipients. Early recognition, prompt investigation and adequate treatment are necessary to improve long-term transplant outcomes.

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