title: Posterior reversible encephalopathy syndrome after kidney transplantation in pediatric recipients: Two cases.
abstract: 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.
authors.affiliation: U.O. Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Antenore
authors.initials: A
authors.lastname: Giussani
authors.affiliation: U.O.C. Nefrologia e Dialisi Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.affiliation: U.O. Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Belingheri
authors.affiliation: U.O. Neurofisiopatologia Servizio di Epilettologia e Neurofisiopatologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Robertino
authors.initials: R
authors.lastname: Dilena
authors.affiliation: U.O. Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Raiteri
authors.affiliation: U.O. Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pasciucco
authors.affiliation: U.O. Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Colico
authors.affiliation: U.O. Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Beretta
mesh_terms: D000592:Amino Acid Metabolism, Inborn Errors / Q000601:surgery; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000077552:Basiliximab; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000188:drug therapy; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery*; D016559:Tacrolimus / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000601:surgery
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab; D016559:Tacrolimus
keywords: calcineurin inhibitors; kidney transplantation; pediatric transplantation; posterior reversible encephalopathy syndrome