title: Calcineurin Inhibitors Associated Posterior Reversible Encephalopathy Syndrome in Solid Organ Transplantation: Report of 2 Cases and Literature Review.
abstract: Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic side effect of calcineurin inhibitors (CNIs) with poorly understood clinical features.We report cases of 2 patients with PRES developing after kidney transplantation and summarize PRES clinical features through a literature review.The 1st case was a 28-year-old man who received a kidney transplant from a deceased donor. Initial immunosuppressive therapy consisted of tacrolimus/mycophenolate mofetil/prednisolone. He developed headache and blurred vision with visual field loss15 days after transplantation and generalized seizures 4 days later. The 2nd case was a 34-year-old man who received a living kidney transplant. His initial immunosuppressive therapy comprised tacrolimus/mycophenolate mofetil/prednisolone. Two months after transplantation, he developed seizures. Both patients were diagnosed with PRES based on neurological symptoms and magnetic resonance imaging (MRI) findings; they recovered after switching from tacrolimus to either a cyclosporine or a lower tacrolimus dose. CNI-associated PRES is an acute neurological syndrome with seizures, encephalopathy, visual abnormalities, headache, focal neurological deficits, and nausea/vomiting. It is always accompanied by hypertension. A fluid-attenuated inversion recovery signal MRI scan typically shows reversible subcortical white matter changes in the posterior cerebral hemisphere that usually occur within the 1st month after transplantation. CNI-associated PRES has a generally favorable prognosis with early diagnosis and prompt treatment including alternating or discontinuing CNIs and blood pressure control.CNI-associated PRES should be considered in patients exhibiting acute neurological symptoms after transplantation. Early diagnosis and immediate treatment are critical for a favorable prognosis.
authors.affiliation: From the Department of Urology, Institute of Urology, Organ Transplantation Center (TS, ZR, YQ, JL, ZH, XW, TL); and The Third Comprehensive Care Unit, West China Hospital, Sichuan University (QT), Chengdu, Sichuan, China.
authors.forename: Turun
authors.initials: T
authors.lastname: Song
authors.forename: Zhengsheng
authors.initials: Z
authors.lastname: Rao
authors.forename: Qiling
authors.initials: Q
authors.lastname: Tan
authors.forename: Yang
authors.initials: Y
authors.lastname: Qiu
authors.forename: Jinpeng
authors.initials: J
authors.lastname: Liu
authors.forename: Zhongli
authors.initials: Z
authors.lastname: Huang
authors.forename: Xianding
authors.initials: X
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Lin
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced*; D011183:Postoperative Complications / Q000139:chemically induced*
chemical_list: D065095:Calcineurin Inhibitors