title: Alternative tacrolimus and sirolimus regimen associated with rapid resolution of posterior reversible encephalopathy syndrome after lung transplantation.
abstract: BACKGROUND
  Neurotoxicity is a significant complication of calcineurin inhibitor use, and posterior reversible encephalopathy syndrome has been reported. Limited data exist on the use of alternative immunosuppression regimens in the management of posterior reversible encephalopathy syndrome in transplant recipients.
  
  
  METHODS
  We present the immunosuppression management strategy of a girl who underwent bilateral lung transplantation for cystic fibrosis 6 months earlier, then suddenly developed a grand mal seizure due to posterior reversible encephalopathy syndrome diagnosed by magnetic resonance imaging of the brain. In an effort to reduce her tacrolimus dose, an alternative immunosuppressant regimen combining tacrolimus and sirolimus was used.
  
  
  RESULTS
  After the modification of her immunosuppressant regimen, there was rapid clinical improvement with no further seizures. Her brain findings had resolved on magnetic resonance imaging 2 months later. Over the next 6 months, allograft function remained stable and surveillance transbronchial biopsies found no allograft rejection on the combined sirolimus and tacrolimus therapy.
  
  
  CONCLUSIONS
  Tacrolimus-associated neurotoxicity resolved in a lung transplant recipient with a combined tacrolimus and sirolimus regimen. This combined therapy appears to be an effective alternative for lung transplant recipients that allow them to receive the benefits of both drugs but at lower doses, which reduces the risk for adverse effects.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Brent
authors.initials: B
authors.lastname: Adler
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Turner
authors.affiliation: Skaggs Center of Pharmaceutical Sciences, The University of Arizona-Tucson College of Pharmacy, Tucson, Arizona.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Mansour
mesh_terms: D000293:Adolescent; D001921:Brain / Q000187:drug effects / Q000473:pathology; D004359:Drug Therapy, Combination; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016040:Lung Transplantation; D008279:Magnetic Resonance Imaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000473:pathology; D020123:Sirolimus / Q000008:administration & dosage* / Q000627:therapeutic use; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus
keywords: lung transplantation; posterior reversible encephalopathy syndrome; sirolimus; tacrolimus