Posterior reversible encephalopathy syndrome after solid organ transplantation

Area of Science:

• Nephrology
• Neurology
• Transplantation Medicine

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological complication observed after solid organ transplantation (SOT).
• Calcineurin inhibitors like cyclosporine and tacrolimus are potential triggers for PRES post-SOT.

Purpose of the Study:

• To determine the frequency of PRES following SOT.
• To characterize the clinical and imaging features of PRES in SOT recipients.

Main Methods:

• Retrospective analysis of 27 patients who developed PRES after SOT.
• Data collected included SOT subtype, PRES incidence and timing, infections, rejection status, mean arterial pressure (MAP), and brain edema characteristics.

Main Results:

• PRES occurred in 0.49% of 4222 SOT patients.
• Liver transplant recipients developed PRES within 2 months, often linked to CMV, mild rejection, or bacterial infection.
• Kidney transplant recipients developed PRES after 1 year, associated with moderate rejection or bacterial infection.
• Liver transplant recipients had lower MAP but greater vasogenic edema compared to kidney transplant recipients.

Conclusions:

• SOT recipients experience a low incidence of PRES, with variations based on transplant type.
• Timing of PRES, MAP, and edema characteristics differ between liver and kidney transplant recipients.
• Elevated MAP in kidney transplant recipients with PRES was paradoxically associated with less brain edema.