Abstract: SA-PO1196
Guillan-Barre: An Infrequent Presentation After Kidney Transplantation
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Lewis, Ian Z., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Patel, Rima, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Introduction
Guillain-Barre syndrome is an acute, autoimmune polyradiculopathy. It has rarely been described in solid organ transplant recipients and may be associated with infections and calcineurin inhibitors. We report a case of Guillain-Barre syndrome in a renal transplant patient presenting with nephrotic range proteinuria and immune complex deposition on biopsy.
Case Description
A 37-year-old female underwent living unrelated kidney transplant for diabetic nephropathy with immediate graft function. She received induction with Thymoglobulin 4.5 mg/kg and was maintained on Tacrolimus (goal trough 8-10 ng/mL) and Mycophenolate Mofetil 1000 mg BID. One year later the patient presented with lower extremity weakness and recurrent falls. Exam revealed areflexia in all extremities. Infectious workup was negative, with lumbar puncture displaying elevated CSF protein. EMG was consistent with acute inflammatory demyelinating polyneuropathy. Her symptoms improved with IVIG x 5 doses. No definitive trigger was identified. Six months later, UPCR rose to 3.7 grams, with lower extremity weakness. Transplant biopsy obtained with DM nephropathy, mild podocyte injury with secondary FSGS, and glomerular immune complex deposition of IGM and C1Q. Repeat IVIG administered with clinical improvement. Given recurrence, CNI minimization pursued with transition to Belatacept.
Discussion
Literature of Guillain-Barre syndrome post renal transplant is limited to case reports. Presentations include ascending, areflexic paralysis, progressing over hours to days (3). Diagnosis may include elevated protein count without pleocytosis on CSF analysis, supported with EMG findings of slowed peripheral nerve action potentials (2). Cases have classically been preceded by respiratory or gastrointestinal infection (1). In a systematic review of 17 cases post renal transplant CMV was identified as the most common trigger, with other risks including CNI use (1). There is no current identified treatment specific to solid organ transplant recipeints. The link between nephrotic syndrome and Guillain-Barre has been described, with cases reporting associated minimal change disease, membranous nephropathy and FSGS (4). In our case, IGM and C1Q presence on IF may suggest an autoimmune response to antigens on podocytes and peripheral nerves given recurrent symptoms and increased proteinuria. Future studies for more directed treatment are necessary to ensure favorable outcomes.
Acknowledgment
Ostman et al, Guillain-Barré syndrome post renal transplant: A systematic review. Transpl Infect Dis. 2019
Jakes et al, Case report: Guillain-Barré syndrome following renal transplantation--a diagnostic dilemma. Nephron Clin Pract. 2013
Kundan et al, Guillain–Barré syndrome post renal transplantation – A rare entity, Clinical Queries: Nephrology, 2015
Guo et al, Nephrotic syndrome associated with Guillain-Barré syndrome and Sjögren syndrome: A case report and lit review. Medicine (Baltimore). 2025