One case of tacrolimus-caused reversible posterior leukoencephalopathy syndrome after renal transplantation in children

doi:10.19803/j.1672-8629.20220643

Abstract

Abstract: Objective To find out more about the reversible posterior leukoencephalopathy syndrome (RPLS) after solid organ transplantation (SOT) in children and to explore the methods of treatment. Methods The clinical data of a child with RPLS caused by tacrolimus after renal transplantation was analyzed. The clinical characteristics, treatment plans and outcomes of RPLS were reviewed by consulting related case reports. Results RPLS was related to high concentrations of tacrolimus, mainly manifested as nervous system symptoms with or without hypertension. Anti-hypertension and antiepileptic therapies and adjustment of immunosuppressants were popularly used. Most of the children could recover within a few weeks, but a small number of children would subsequently suffer neurological disorders or even die. Conclusion Blood concentrations of immunosuppressants in children after SOT have to be closely monitored while nervous system symptoms and blood pressure deserve attention. Early identification of RPLS and prompt treatment can improve the prognosis.

Key words: tacrolimus, reversible posterior leukoencephalopathy syndrome (RPLS), children, organ transplantation, neurological disorders, adverse drug reactiom

CLC Number:

ZHANG Zhiqi, GUO Mingxing, XU Ye, ZHANG Jian, LIN Jun, CUI Xiangli. One case of tacrolimus-caused reversible posterior leukoencephalopathy syndrome after renal transplantation in children[J]. Chinese Journal of Pharmacovigilance, 2023, 20(4): 465-468.

References

[1] Organ Transplantation Branch of Chinese Medical Association. Technical specifications for clinical application of immunosuppressants in organ transplantation (2019 version)[J]. Organ Transplantation(器官移植), 2019, 10(3): 213-226.
[2] CHEN X, ZHU W, JIANG S.A case report of reversible posterior encephalopathy syndrome with intracranial hemorrhage in a child[J]. Medicine, 2021, 100(12): e25266.
[3] ACAR S, KAVLAK ME, DEMIR B, et al.Posterior reversible encephalopathy syndrome in a five-year-old child: A case report[J]. Transplantation Proceedings, 2019, 51(7): 2495-2497.
[4] ARAZ C, CAMKIRAN A, ZEYNELOGLU P, et al.Early-onset posterior reversible encephalopathy syndrome after solid organ transplantation in pediatric patients: a report of 2 cases[J]. Transplantation Proceedings, 2013, 45(10): 3555-3557.
[5] GHOSH PS, KWON C, KLEIN M, et al.Neurologic complications following pediatric renal transplantation[J]. Journal of Child Neurology, 2014, 29(6): 793-798.
[6] SANTOS MM, TANNURI AC, GIBELLI NE, et al.Posterior reversible encephalopathy syndrome after liver transplantation in children: a rare complication related to calcineurin inhibitor effects[J]. Pediatric Transplantation, 2011, 15(2): 157-160.
[7] YILMAZ S, GOKBEN S, ARIKAN C, et al.Reversibility of cytotoxic edema in tacrolimus leukoencephalopathy[J]. Pediatric Neurology, 2010, 43(5): 359-362.
[8] EROL I, ALEHAN F, OZCAY F, et al.Neurological complications of liver transplantation in pediatric patients: a single center experience[J]. Pediatric Transplantation, 2007, 11(2): 152-159.
[9] ISHIKURA K, IKEDA M, HAMASAKI Y, et al.Posterior reversible encephalopathy syndrome in children: its high prevalence and more extensive imaging findings[J]. American Journal of Kidney Disease, 2006, 48(2): 231-238.
[10] ZHAO K, LIU YH, GAO W, et al.Early severe neurological complications after pediatric liver transplantation: a report of 15 patients[J]. Clin J Hepatobiliary Surg(中华肝胆外科杂志), 2020, 26(11): 812-815.
[11] ROSSO L, NOSOTTI M, MENDOGNI P, et al.Lung transplantation and posterior reversible encephalopathy syndrome: a case series[J]. Transplantation Proceedings, 2012, 44(7): 2022-2025.
[12] GIUSSANI A, ARDISSINO G, BELINGHERI M, et al.Posterior reversible encephalopathy syndrome after kidney transplantation in pediatric recipients: two cases[J]. Pediatric Transplantation, 2016, 20(1): 68-71.
[13] DILENA R, NEBBIA G, FIORICA L, et al.Epilepsy surgery in a liver-transplanted girl with temporal lobe epilepsy and hippocampal sclerosis following PRES with status epilepticus[J]. European Journal of Pediatric Neurology, 2016, 20(4): 652-656.
[14] ZHAO K, CAI J.A case of early reversible posterior leukoencephalopathy syndrome after renal transplantation in children[J]. Practical Journal of Organ Transplantaiton (Electronic Version), 2020, 8(2): 121-122.
[15] SAVAJ S, FARASATINASAB M, AMOUZEGAR A.Irreversible lesions of tacrolimus-induced posterior reversible leukoencephalopathy syndrome[J]. Iranian Journal of Kidney Diseases, 2017, 11(6): 408.
[16] MARIA ALEXANDRE A, NAPOLI G, SANNA A, et al.Posterior reversible encephalopathy syndrome in children, epiphenomenon of a known or unknown disease[J]. Journal of Pediatric Neuroradiology, 2014, 3(2): 99-103.
[17] HODZIC E, BRCIC M, ATIC M, et al.Posterior reversible encephalopathy syndrome (RPLS) as a complication of immunosuppressive therapy in renal transplantation in children[J]. Medicine (Baltimore), 2014, 68(3): 218-220.
[18] GHOSH PS, KWON C, KLEIN M, et al.Neurologic complications following pediatric renal transplantation[J]. Journal of Child Neurology, 2014, 29(6): 793-798.
[19] WANG HY, QU Q,S ZHANG JD, et al. A case of posterior white matter encephalopathy after renal transplantation in children[J]. Chinese Journal of Organ Transplantation(中华器官移植杂志), 2018, 39(1): 53-54.
[20] YAMAGISHI H, CHEN-YOSHIKAWA TF, DATE H.Basiliximab for posterior reversible encephalopathy syndrome after lung transplantation[J]. European Journal of Cardio-Thoracic Surgery, 2017, 52(4): 823-824.
[21] ARIMURA FE, CAMARGO PC, COSTA AN, et al.Posterior reversible encephalopathy syndrome in lung transplantation: 5 case reports[J]. Transplantation Proceedings, 2014, 46(6): 1845-1848.
[22] HAYES D, ADLER B, TURNER TL, et al.Alternative tacrolimus and sirolimus regimen associated with rapid resolution of posterior reversible encephalopathy syndrome after lung transplantation[J]. Pediatric Neurology, 2014, 50(3): 272-275.
[23] SHOJI T, BANDO T, FUJINAGA T, et al.Posterior reversible encephalopathy syndrome due to immunosupRPLSsant after living-donor lobar lung transplantation: report of a case[J]. General Thoracic and Cardiovascular Surgery, 2012, 60(8): 514-517.
[24] TSANG BK, KERMEEN FD, HOPKINS PM, et al.Reversible posterior leukoencephalopathy syndrome: diagnosis and management in the setting of lung transplantation[J]. Internal Medicine Journal, 2010, 40(10): 716-720.
[25] ARAZ C, CAMKIRAN A, ZEYNELOGLU P, et al.Early-onset posterior reversible encephalopathy syndrome after solid organ transplantation in pediatric patients: a report of 2 cases[J]. Transplantation Proceedings, 2013, 45(10): 3555-3557.
[26] LOAR RW, PATTERSON MC, O'LEARY PW, et al. Posterior reversible encephalopathy syndrome and hemorrhage associated with tacrolimus in a pediatric heart transplantation recipient[J]. Pediatric Transplantation, 2013, 17(2): E67-70.
[27] TEOTÓNIO R, MARMOTO D, JANUÁRIO C, et al. Posterior reversible encephalopathy syndrome: the importance of early diagnosis[J]. BMJ Case Reports, 2012, 2012: bcr2012006852.
[28] GUIMARAES V, MARIANO N, SUNDIN M, et al.Status epilepticus due to reversible posterior leukoencephalopathy after pediatric heart transplantation[J]. Pediatric Transplantation, 2011, 15: 73.
[29] SCHMID F, BENDEN C, INCI I, et al.“One for two”: Favorable mid-term outcome following simultaneous lobar lung transplantation in two adolescents[J]. Pediatric Transplantation, 2015, 19(Suppl 1): 81.
[30] PARIKH NS, SCHWEITZER AD, YOUNG RJ, et al.Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome[J]. Journal of the Neurological Sciences, 2017, 380: 11-15.
[31] KHAJURIA B, KHAJURIA M, AGRAWAL Y.Mycophenolate-induced posterior reversible encephalopathy syndrome[J]. American Journal of Therapeutics, 2016, 23(4): e1072-e1073.
[32] XU W, ZHOU Y, WU YN, et al.Clinical and imaging features of reversible posterior leukoencephalopathy[J]. Chinese Journal of Nervous and Mental Disease(中国神经精神疾病杂志), 2019, 45(1): 42-46.
[33] LI C, ZHOU Y, FU Y.MRI manifestations and differential diagnosis of reversible posterior leukoencephalopathy syndrome[J]. Journal of Nantong University (Medical Science), 2019, 39(2): 148-150.
[34] THAVAMANI A, UMAPATHI KK, PULIYEL M, et al.Epidemiology, comorbidities, and outcomes of posterior reversible encephalopathy syndrome in children in the United States[J]. Pediatric Neurology, 2020, 103: 21-26.
[35] ZHANG J, CHU MM, LI LT, et al.One case of epileptic seizure induced by increased blood concentration of cyclosporine injection[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2019, 16(4): 248-251.
[36] CAMMOCK C, CHOUDHRY S, CASTLEBERRY CM, et al.Early stroke post-heart transplant is associated with decreased survival in children[J]. Journal of Heart and Lung Transplantation, 2018, 37(6): 733-739.
[37] SEZER T, BALCI SEZER O, ÖZCAY F, et al.Efficacy of levetiracetam for epilepsy in pediatric liver transplant recipients with posterior reversible encephalopathy syndrome[J]. Experimental and Clinical Transplantation, 2020, 18(Suppl 1): 96-98.
[38] POWER A, MURRAY JM, DYKES JC, et al.Neurologic events following pediatric heart transplantation[J]. Journal of Heart and Lung Transplantation, 2021, 40(4): S198-S199.