Two rare neurologic complications after heart transplantation: Posterior reversible encephalopathy syndrome, followed by reversible cerebral vasoconstriction syndrome

Park, Chan Soon; Park, Jin Joo

doi:10.1016/j.healun.2016.01.1221

Cited by 9 publications

(6 citation statements)

References 4 publications

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“…Post-transplant patients on immunosuppressive medications such as tacrolimus may well be an underrecognized population at risk for RCVS and subsequent neurological deficits. [7][8][9][10][11] Further, it is imperative to recognize this condition even in pediatric patients, despite the relative lack of reported cases in the literature. Suggestions for recognition, workup, and management of RCVS in post-transplant patients have been summarized in ►Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative immunosuppression used for RCVS in heart transplant patients includes basiliximab, sirolimus, and everolimus (after wound healing). [7][8][9][10][11] Cyclosporine is not a recommended therapy as it is a calcineurin inhibitor that may cause vasospasm in a similar manner as tacrolimus. Sirolimus was used in our patient without any adverse events noted on a 5-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…All the case reports we identified on RCVS after heart transplantation suggest tacrolimus as the suspected contributing factor (►Table 1). [7][8][9][10][11] In a French prospective cohort study, the offending agent for RCVS was a vasoactive drug in 55% of patients. 13 Such vasoactive substances included selective serotonin reuptake inhibitors, sympathomimetics, and nasal decongestants.…”

Section: Discussionmentioning

confidence: 99%

“…The current literature pertaining to tacrolimus-induced RCVS after heart transplantation is quite limited, entailing five case reports (►Table 1), which we found after searching PubMed and Google Scholar using the terms "RCVS" and "tacrolimus." [7][8][9][10][11] Two of these cases were also attributed to posterior -Verapamil intraarterial injection, then orally.…”

Section: Introductionmentioning

confidence: 99%

“…Tacrolimus suppresses cellular immunity through calcineurin inhibition. The current literature pertaining to tacrolimus-induced RCVS after heart transplantation is quite limited, entailing five case reports ( Table 1 ), which we found after searching PubMed and Google Scholar using the terms “RCVS” and “tacrolimus.” 7 8 9 10 11 Two of these cases were also attributed to posterior reversible encephalopathy syndrome (PRES) with tacrolimus as the trigger. Only one case implicated a pediatric patient at 15 years of age.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Tacrolimus-Induced Reversible Cerebral Vasoconstriction Syndrome after Heart Transplantation

Shabo

Ishaque

Sarathy

et al. 2022

Journal of Pediatric Neurology

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Reversible cerebral vasoconstriction syndrome (RCVS) is a rare post-organ transplantation complication. While uncommon, complications of post-transplant RCVS can be devastating, with sequelae including ischemic or hemorrhagic stroke and potential significant neurological morbidity. There is a paucity of literature on tacrolimus-mediated RCVS, particularly in the pediatric population. To date, only five case reports have been published, with the youngest patient being 15 years of age. We report the youngest case to date of post-heart transplant tacrolimus-induced RCVS in a 6-year-old male. The present case highlights the necessity of urgent imaging in suspected cases of RCVS, the potential diagnostic challenges surrounding the etiology of headache, the benefits of treating underlying cerebral vasospasm, and the importance of rapid discontinuation of the offending agent for the remission of symptoms and prevention of long-term sequelae.

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