Korean J Transplant.  2023 Nov;37(Suppl 1):S20. 10.4285/ATW2023.F-5862.

Posterior reversible encephalopathy syndrome occurring in heart transplant recipients under a hypertensive state

• Lim JH
• Lee SY

• KMID: 2551594
• DOI: http://doi.org/10.4285/ATW2023.F-5862

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease possibly associated with autoregulatory failure, hypertension and the use of calcineurin inhibitors (CNi). From 2014 to January 2023, there were four patients diagnosed with PRES among heart transplantation (HTx) recipients in our center. Among these four patients, three experienced gener-alized tonic-clonic seizure, and three showed changes in consciousness level. Three out of the four patients developed PRES during the early phase within 7 days after the HTx, while one patient presented with PRES 34 days post-HTx. Two out of the four patients exhibited typical radiologic features. All four patients had sustained hypertension prior to the onset of PRES. In two patients, antiepileptic and antihypertensive medications were administered without discontinuing tacrolimus, while one patient discontinued tacrolimus, and the remaining patient had not used calcineurin inhibitors (CNIs) prior to PRES. Three out of the four patients recovered without recurrence of PRES, whereas one patient died due to complications after altered con-sciousness. Hypertension was observed in all patients prior to PRES, and most of patients showed improvement of symptom with blood pressure control. Although CNI is known to be associated with PRES, the patients who maintained therapeutic levels without discontinuing CNI had not experienced a recurrence after the PRES.