Early-Onset Posterior Reversible Encephalopathy Syndrome After Solid Organ Transplantation in Pediatric Patients: A Report of 2 Cases

Araz, Çoşkun; Camkiran, Aynur; Zeyneloğlu, Pınar; Sezgin, Alpay Turan; Moray, Gökhan; Pirat, Arash; Arslan, G.

doi:10.1016/j.transproceed.2013.08.101

Cited by 7 publications

(8 citation statements)

References 8 publications

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“…PRES was found to occur early after transplantation in our patients, compared to adult studies that describe a mean time to presentation of 21 months after heart transplant (n = 4), 45 days after liver transplant (n = 10), and 52 months after kidney transplant (n = 9) . Our findings are consistent with three previous single case reports in children after heart transplantation that described PRES at four , 10 , and 21 days after transplant. Multiple case reports and one single‐center study also describe early occurrence of PRES after pediatric liver transplant, within 1–3 weeks of receiving a transplant .…”

Section: Discussionsupporting

confidence: 90%

“…This is the first observational study on PRES in pediatric heart transplant recipients as prior descriptions are limited to single case reports . PRES occurred in 5.5% of pediatric heart transplant recipients in our study, which is comparable to the reported prevalence after pediatric kidney transplant (4.4%) , but lower than described after pediatric liver transplantation (10%) .…”

Section: Discussionsupporting

confidence: 76%

“…PRES after adult solid organ transplant has been linked to the use of CNI , metabolic derangements , and hypertension . There are few studies investigating PRES in children , and data on PRES in children after solid organ transplant are limited to case reports . Our aim was to determine the prevalence and clinical features of PRES in pediatric HTx recipients.…”

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confidence: 99%

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Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Eilers

Albers

Law

et al. 2016

Pediatric Transplantation

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Identification of risk factors for PRES after organ transplant can improve early detection and avoid permanent neurological injury. High calcineurin-inhibitor levels and hypertension are recognized risk factors for PRES in adult transplant recipients. Limited data exist regarding PRES after pediatric HTx, with studies limited to case reports. We performed a retrospective review of 128 pediatric HTx recipients to identify risk factors for PRES. Seven of 128 (5.5%) recipients developed PRES at a median of 10 days (5-57) after HTx. The median age of recipients with PRES was 10.0 yr (5.7-19.0), compared to 1.4 yr (0.0-19.8) for recipients without PRES (p = 0.010). Fewer than half of recipients with PRES had elevated post-transplant calcineurin-inhibitor levels (n = 3) and/or preceding severe hypertension (n = 3). Four of seven who developed PRES (57%) had pretransplant Glenn or Fontan physiology (G/F). G/F was a significant risk factor for PRES (RR 4.99, 95% CI: 1.19-21.0, p = 0.036). Two recipients (29%), both with severe PRES, had residual neurological symptoms. In summary, PRES occurred in 5.5% of pediatric HTx recipients and presented early after HTx. All recipients with PRES were > 5 yr. Patients with pretransplant G/F were at increased risk, a risks factor not previously described.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 76%

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Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Eilers

Albers

Law

et al. 2016

Pediatric Transplantation

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“…Since its first description in early 1990, many cases of PRES in organ transplantation recipients have been described, but the majority of them are adults. The few reports involving children seem to indicate a higher frequency of PRES in this age group (as high as >5%) (9)(10)(11)(12)(13). In a study reporting neurological complications occurring after renal transplantation in children, two cases of acute postoperative PRES over 113 operated children (2.2%) have been observed (10).…”

Section: Discussionmentioning

confidence: 99%

“…The few reports involving children seem to indicate a higher frequency of PRES in this age group (as high as >5%) (9)(10)(11)(12)(13). In a study reporting neurological complications occurring after renal transplantation in children, two cases of acute postoperative PRES over 113 operated children (2.2%) have been observed (10). At our center over 105 cases of kidney transplantation in children during the last 13 yr, two cases of acute postoperative PRES have been observed, which defines a very similar frequency to that reported by Ghosh.…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome after kidney transplantation in pediatric recipients: Two cases

Giussani

Ardissino

Belingheri

et al. 2015

Pediatric Transplantation

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PRES is a neuro-clinical and radiological syndrome that can result as a consequence of several different conditions including hypertension, fluid overload, and immunosuppressive treatment. Herein, we report two children who received kidney and combined liver-kidney transplantation as treatment for renal hypodysplasia associated with bilateral vesico-ureteral reflux and methylmalonic acidemia, respectively. Early after surgery (seven and 10 days), both patients presented with hypertension and seizures. The patients' immunosuppressive regimen included steroid and calcineurin inhibitors (tacrolimus and cyclosporine, respectively) and basiliximab and one with anti-IL2 receptor. In both cases, the imaging strongly supported the diagnosis of PRES. In details, the CT scan showed hypodensities in the posterior areas of the brain, and brain MRI demonstrated parieto-occipital alterations indicative of vasogenic edema. Treatment with calcineurin inhibitors was temporally discontinued and restarted at lower dosage; arterial hypertension was treated with Ca-channel blockers. Both children fully recovered without any neurological sequels. In conclusion, in children undergoing solid organ transplantation, who develop neurological symptoms PRES, should be carefully considered in the differential diagnosis and once the diagnosis is ruled in, we recommend strict arterial blood pressure control and adjustment or withholding of calcineurin inhibitor therapy should be considered based upon blood levels.

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Posterior Reversible Encephalopathy Syndrome After Transplantation: a Review

Chen

et al. 2015

Mol Neurobiol

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Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease. Recently, an increase in the number of transplantations has led to more cases being associated with PRES than what was previously reported. Calcineurin inhibitors (CNIs) are major risk factors for PRES in posttransplantation patients. The mechanisms of the development of PRES remain to be unclear. The typical clinical symptoms of PRES include seizures, acute encephalopathy syndrome, and visual symptoms. The hyperintense signal on fluid-attenuated inversion recovery image is the characteristic of the imaging appearance in these patients. In addition, other abnormal signals distributed in multiple locations are also reported in some atypical cases. Unfortunately, PRES is often not recognized or diagnosed too late due to complicated differential diagnoses, such as ischemic stroke, progressive multifocal leukoencephalopathy, and neurodegenerative diseases. Thus, this review emphasizes the importance of considering the possibility of PRES when neurological disturbances appear after solid organ transplantation or hematopoietic cell transplantation. Moreover, this review demonstrates the molecular mechanisms of PRES associated with CNIs after transplantation, which aims to help clinicians further understand PRES in the transplantation era.

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Early-Onset Posterior Reversible Encephalopathy Syndrome After Solid Organ Transplantation in Pediatric Patients: A Report of 2 Cases

Cited by 7 publications

References 8 publications

Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Posterior reversible encephalopathy syndrome after kidney transplantation in pediatric recipients: Two cases

Posterior Reversible Encephalopathy Syndrome After Transplantation: a Review

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