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Posterior reversible encephalopathy syndrome after pediatric heart transplantation: Increased risk for children with preexisting Glenn/Fontan physiology
Author(s) -
Eilers Braiden,
Albers Erin,
Law Yuk,
McMullan D. Mike,
Shaw Dennis,
Kemna Mariska
Publication year - 2016
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12702
Subject(s) - medicine , posterior reversible encephalopathy syndrome , calcineurin , risk factor , transplantation , heart transplantation , pathophysiology , pediatrics , gastroenterology , cardiology , surgery , magnetic resonance imaging , radiology
Abstract 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 HT x, with studies limited to case reports. We performed a retrospective review of 128 pediatric HT x recipients to identify risk factors for PRES . Seven of 128 (5.5%) recipients developed PRES at a median of 10 days (5–57) after HT x. 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 HT x recipients and presented early after HT x. All recipients with PRES were > 5 yr. Patients with pretransplant G/F were at increased risk, a risks factor not previously described.