Posterior Reversible Encephalopathy Syndrome After Pediatric Heart Transplantation

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Abstract

Introduction

Posterior reversible encephalopathy syndrome (PRES), is a clinicoradiological syndrome that manifested with various neurological signs such as seizure, headache, altered mental function and visual disturbances in organ transplant patients. Hypertension, metabolic derangements and use of calcineurin inhibitors in heart transplant patient are reported as strongly factors which linked to adult PRES however data about PRES after pediatric heart transplant (PHT) is limited. In present study, we aim to determine the prevalence and clinical features of PRES in PHT recipients.

Materials and Methods

We performed a retrospective review of 37 PHT recipients <22 yo, who received their transplant at our institution between 2007-2017. Medical records were reviewed to identify for PRES diagnosis. Demographic and clinical risk factors were analyzed in development of PRES.

Results

Seven of 37 (18.9%) recipient developed PRES at a median of 5 days (1-42) after transplant. The median age of recipients with PRES was 14 years (12-18). Recipients with PRES did not differ from those without PRES when comparing age, gender, BMI, total allograft ischemic time, aortic cross-clamp time or cardiopulmonary bypass time. All patients has presented with seizure, 4 patients had elevated blood pressure (<95 percentile) and one patient had CNI levels higher than their target range.

Conclusion

The prevalence of PRES in PHT recipients appear higher than reported in adult patients. Awareness of PRES in PHT patients should became more important, therefore neurological signs, blood pressure and level of calcineurin inhibitors should be closely monitored in these patients

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