Posterior reversible encephalopathy syndrome after liver transplantation in children: A rare complication related to calcineurin inhibitor effects

• Published in: Pediatric transplantation Vol. 15; no. 2; pp. 157 - 160
• Main Authors: Santos, Maria M., Tannuri, Ana Cristina A., Gibelli, Nelson E., Ayoub, Ali A., Maksoud-Filho, João G., Andrade, Wagner C., Velhote, Manoel C. P., Silva, Marcos M., Pinho, Maria L., Miyatani, Helena T., Susuki, Liza, Tannuri, Uenis
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2011; Blackwell
• Subjects: Adolescent; adverse event; Alagille Syndrome; Biliary atresia; Biliary Atresia - diagnosis; Biliary Atresia - surgery; Biological and medical sciences; Blood pressure; Brain; Calcineurin - adverse effects; calcineurin inhibitor; Calcineurin Inhibitors; Child; Children; Computed tomography; Cyclosporins - adverse effects; Cyclosporins - therapeutic use; Differential diagnosis; Encephalopathy; Female; Follow-Up Studies; General aspects; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hepatic encephalopathy; Humans; Hypertension; Hypertensive Encephalopathy - chemically induced; Hypertensive Encephalopathy - diagnosis; immunosuppression; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Innervation; Liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical sciences; Monitoring, Physiologic - methods; Nervous system (semeiology, syndromes); Neurological complications; Neurology; neurotoxicity; Posterior Leukoencephalopathy Syndrome - chemically induced; Posterior Leukoencephalopathy Syndrome - diagnosis; posterior reversible encephalopathy syndrome; Rare Diseases; Risk Assessment; Seizures; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; tacrolimus; Transplantation; Transplantation Immunology - physiology; Transplants; Pediatrics; Calcineurin inhibitor; Toxicity; Liver; Nervous system; Homotransplantation; Neurotoxicity; Posterior reversible encephalopathy syndrome; Surgery; Secondary effect; Complication; Graft; Protein synthesis inhibitor; Child; Human; Drug; Nervous system diseases; Digestive system; Lactone; adverse event; Pharmacovigilance; Macrolide; Cerebral disorder; Immunomodulator; Immunosuppression; Treatment; Tacrolimus; Central nervous system disease; Immunosuppressive agent; Antibacterial agent; Liver transplantation
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2010.01430.x

Santos MM, Tannuri ACA, Gibelli NE, Ayoub AA, Maksoud‐Filho JG, Andrade WC, Velhote MCP, Silva MM, Pinho ML, Miyatani HT, Suzuki L, Tannuri U. Posterior reversible encephalopathy syndrome after liver transplantation in children: A rare complication related to calcineurin inhibitor effects.
Pediatr Transplantation 2011: 15:157–160. © 2010 John Wiley & Sons A/S. :  PRES is a neuroclinical and radiological syndrome that results from treatment with calcineurin inhibitor immunosuppressives. Severe hypertension is commonly present, but some patients may be normotensive. We report herein two children who received liver transplants, as treatment for biliary atresia in the first case and for Alagille’s syndrome in the second one. In the early postoperative, both patients presented hypertension and seizures. In both cases, the image findings suggested the diagnosis of PRES. The CT scan showed alterations in the posterior area of the brain, and brain MRI demonstrated parietal and occipital areas of high signal intensity. Both children were treated by switching the immunosuppressive regimen and controlling arterial blood pressure. They displayed full recuperation without any neurologic sequelae. Probably, the pathophysiology of PRES results from sparse sympathetic innervation of the vertebrobasilar circulation, which is responsible for supplying blood to the posterior areas of the brain. In conclusion, all liver‐transplanted children who present with neurological symptoms PRES should be considered in the differential diagnosis, although this is a rare complication. As treatment, we recommend rigorous control of arterial blood pressure and switching the immunosuppressive regimen.