Posterior reversible encephalopathy syndrome after kidney transplantation in pediatric recipients: Two cases

Pediatric Transplantation - Tập 20 Số 1 - Trang 68-71 - 2016
Antenore Giussani1,2,3, Gianluigi Ardissino4, Mirco Belingheri5, Robertino Dilena6, M. Raiteri3, A. Pasciucco3, Caterina Colico3, Claudio Beretta3
1Antenore Giussani, Via Francesco Sforza n 3521100, Milano, Italia
2Tel.: +39 333 2875754
3U.O. Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
4U.O.C. Nefrologia e Dialisi Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
5U.O. Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
6U.O. Neurofisiopatologia Servizio di Epilettologia e Neurofisiopatologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy

Tóm tắt

AbstractPRES 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.

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Tài liệu tham khảo

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Pediatric Transplantation

Tập 20 Số 1

68-71

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