Neurologic Complications Following Pediatric Renal Transplantation

Ghosh, Partha S.; Kwon, Charles; Klein, M; Corder, Julie; Ghosh, Debabrata

doi:10.1177/0883073813490074

Cited by 8 publications

(10 citation statements)

References 30 publications

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“…This is the first observational study on PRES in pediatric heart transplant recipients as prior descriptions are limited to single case reports . PRES occurred in 5.5% of pediatric heart transplant recipients in our study, which is comparable to the reported prevalence after pediatric kidney transplant (4.4%) , but lower than described after pediatric liver transplantation (10%) .…”

Section: Discussionsupporting

confidence: 76%

“…Multiple case reports and one single‐center study also describe early occurrence of PRES after pediatric liver transplant, within 1–3 weeks of receiving a transplant . In contrast, PRES after pediatric kidney transplant appears to occur both early and late (>3 months after transplant) .…”

Section: Discussionmentioning

confidence: 99%

“…PRES after adult solid organ transplant has been linked to the use of CNI , metabolic derangements , and hypertension . There are few studies investigating PRES in children , and data on PRES in children after solid organ transplant are limited to case reports . Our aim was to determine the prevalence and clinical features of PRES in pediatric HTx recipients.…”

mentioning

confidence: 99%

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Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Eilers

Albers

Law

et al. 2016

Pediatric Transplantation

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Identification of risk factors for PRES after organ transplant can improve early detection and avoid permanent neurological injury. High calcineurin-inhibitor levels and hypertension are recognized risk factors for PRES in adult transplant recipients. Limited data exist regarding PRES after pediatric HTx, with studies limited to case reports. We performed a retrospective review of 128 pediatric HTx recipients to identify risk factors for PRES. Seven of 128 (5.5%) recipients developed PRES at a median of 10 days (5-57) after HTx. The median age of recipients with PRES was 10.0 yr (5.7-19.0), compared to 1.4 yr (0.0-19.8) for recipients without PRES (p = 0.010). Fewer than half of recipients with PRES had elevated post-transplant calcineurin-inhibitor levels (n = 3) and/or preceding severe hypertension (n = 3). Four of seven who developed PRES (57%) had pretransplant Glenn or Fontan physiology (G/F). G/F was a significant risk factor for PRES (RR 4.99, 95% CI: 1.19-21.0, p = 0.036). Two recipients (29%), both with severe PRES, had residual neurological symptoms. In summary, PRES occurred in 5.5% of pediatric HTx recipients and presented early after HTx. All recipients with PRES were > 5 yr. Patients with pretransplant G/F were at increased risk, a risks factor not previously described.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Eilers

Albers

Law

et al. 2016

Pediatric Transplantation

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“…The most popular theory relies upon blood–brain barrier dysfunction secondary to hypertension, but blood pressure is normal or mildly elevated in 30% of cases . A second theory is based on the role of endothelial dysfunction due to circulating toxins in sepsis, immunosuppression, and autoimmune disease . Another theory is ischemic edema secondary to focal vasospasm and blood flow reduction, and according to this interpretation, it is speculated that systemic hypertension is finalized at maintaining the cerebral blood flow .…”

Section: Discussionmentioning

confidence: 99%

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

Giussani

Ardissino

Belingheri

et al. 2015

Pediatric Transplantation

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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.

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“…Solid organ transplants performed in the United States in 2015 exceeded 30,000 and continued to increase ( 1 ). Although remarkable advances in transplantation medicine improved the outcomes of allogeneic graft recipients, neurologic complications are still common with variety incidence ranging from 7% to 77% of allograft recipients after HSCT and solid or gan transplantation ( 2 3 4 5 6 7 8 9 10 11 12 ). One of the most deleterious neurologic complications is transplant-associated encephalopathy, which has various etiologies, including the underlying disorder motivating the transplant, immunosuppressant neurotoxicity, metabolic derangement, central nervous system (CNS) infection, and stroke ( 9 12 13 14 15 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Transplant-associated Encephalopathy in Children

et al. 2017

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We aimed to analyze characteristics of encephalopathy after both hematopoietic stem cell and solid organ pediatric transplantation. We retrospectively reviewed medical records of 662 pediatric transplant recipients (201 with liver transplantation [LT], 55 with heart transplantation [HT], and 67 with kidney transplantation [KT], 339 with allogeneic hematopoietic stem cell transplantation [HSCT]) who received their graft organs at Asan Medical Center between January 2000 and July 2014. Of the 662 patients, 50 (7.6%) experienced encephalopathy after transplantation. The incidence of encephalopathy was significantly different according to the type of organ transplant: LT, 16/201 (8.0%), HT, 13/55 (23.6%), KT, 5/67 (7.5%), and HSCT, 16/339 (4.7%) (P < 0.001). Drug-induced encephalopathy (n = 14) was the most common encephalopathy for all transplant types, but particularly after HSCT. Hypertensive encephalopathy was the most common after KT and HT, whereas metabolic encephalopathy was the most common after LT. The median time to encephalopathy onset also differed according to the transplant type: 5 days after KT (range 0–491 days), 10 days after HT (1–296 days), 49.5 days after HSCT (9–1,405 days), and 39 days after LT (1–1,092 days) (P = 0.018). The mortality rate among patients with encephalopathy was 42.0% (n = 21/50). Only 5 patients died of neurologic complications. Transplant-associated encephalopathy presented different characteristics according to the type of transplant. Specialized diagnostic approach for neurologic complications specific to the type of transplant may improve survival and quality of life in children after transplantation.

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Neurologic Complications Following Pediatric Renal Transplantation

Cited by 8 publications

References 30 publications

Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology

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

Clinical Characteristics of Transplant-associated Encephalopathy in Children

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