Download PDF
CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg Rep 2021; 10(01): e59-e60
DOI: 10.1055/s-0041-1732344
Case Report: Cardiac

CSA-Induced PRES after Heart Transplantation—Report of Two Cases and Review

Katharina Huenges
1   Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Philipp Kolat
1   Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Bernd Panholzer
1   Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Assad Haneya
1   Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease possibly associated with the use of calcineurin inhibitors (CNI) like cyclosporine A.

Case Description The case of a patient who developed severe PRES under CNI therapy shortly after heart transplantation is presented here. Cerebral computed tomography led to the diagnose of PRES in our patient. New therapy strategy with a quadruple immunosuppressive protocol (cortisone, mycophenolate mofetil, low-dose CNI, and a mechanistic target of rapamycin inhibitor) was started.

Conclusion Under the quadruple therapy, a neurologic recovery occurred. In PRES, the presented alternative therapy strategy may lead to improving neurological conditions and preserved transplant organ functions.

Keywords

heart transplantation - immunusuppression - rejection


Publication History

Received: 28 December 2020

Accepted: 12 April 2021

Article published online:
10 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Song T, Rao Z, Tan Q. et al. Calcineurin inhibitors associated posterior reversible encephalopathy syndrome in solid organ transplantation: report of 2 cases and literature review. Medicine (Baltimore) 2016; 95 (14) e3173 DOI: 10.1097/MD.0000000000003173.
    CrossrefPubMedGoogle Scholar
  • 2 Ramirez R, Muskula PR, Everley MP. Posterior reversible encephalopathy syndrome after orthotopic heart transplantation: a case report. Am J Case Rep 2017; 18: 487-490 http://www.ncbi.nlm.nih.gov/pubmed/28465499 Accessed May 12, 2021
    CrossrefPubMedGoogle Scholar
  • 3 Oda N, Kato TS, Hanatani A. et al. Reversible posterior leukoencephalopathy syndrome (RPLS) in a heart transplant recipient treated by substitution of cyclosporine A with tacrolimus. Intern Med 2010; 49 (11) 1013-1016 http://www.ncbi.nlm.nih.gov/pubmed/20519818 Accessed May 12, 2021
    CrossrefPubMedGoogle Scholar
  • 4 Loar RW, Patterson MC, O'Leary PW, Driscoll DJ, Johnson JN. Posterior reversible encephalopathy syndrome and hemorrhage associated with tacrolimus in a pediatric heart transplantation recipient. Pediatr Transplant 2013; 17 (02) E67-E70
    CrossrefPubMedGoogle Scholar