Brain MR imaging abnormalities in kidney transplant recipients.
OBJECTIVE
On the basis of limited available data, brain MR imaging abnormalities in kidney transplant recipients (KTRs) have been predominantly attributed to calcineurin inhibitors (CIs), characteristically presenting as posterior reversible encephalopathy syndrome (PRES). The goal of this study was to evaluate whether CIs play an important role in the incidence, nature, and location of MR imaging brain lesions in adult KTRs by comparing them with dialysis-dependent patients.


METHODS
We retrospectively analyzed 98 brain MR imaging examinations in 77 consecutive KTRs presenting with neurologic symptoms from 1990 to 2003. The data were separated into 3 groups according to duration after transplantation of MR imaging: group 1, 0-3 months; group 2, 3-12 months; and group 3, >12 months. Twenty-six MR imaging examinations from 24 additional dialysis-dependent adults were used as controls and comprised group 0.


RESULTS
Acute changes (infarcts, infections, PRES) comprised 24% and 19% of lesions in KTRs and group 0 patients, respectively, with infarcts being the most common in all groups. Chronic lesions were responsible for 76% of changes in KTR and 81% in group 0 and were predominantly vascular in etiology. No statistically significant differences in incidence of PRES or other acute changes were found between dialysis-dependent patients and either individual KTR groups or all KTR patients combined. The deep gray matter lesions were more common in KTR, whereas frontal white matter was more frequently affected in patients on dialysis.


CONCLUSIONS
Our study does not support suggestion that MR imaging brain abnormalities in KTR are predominantly due to direct CI toxicity.
Besenski
Nada
N
Department of Radiology, Medical University of South Carolina, Charleston, SC 29425, USA.
Rumboldt
Zoran
Z
Emovon
Osemwegie
O
Nicholas
Joyce
J
Kini
Sunil
S
Milutinovic
Jovan
J
Budisavljevic
Milos N
MN
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology; D065095:Calcineurin Inhibitors; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents