Literature case analysis of tacrolimus-associated posterior reversible encephalopathy syndrome in patients after kidney transplantation
10.3760/cma.j.cn114015-20201009-01019
- VernacularTitle:肾移植后他克莫司相关可逆性后部脑病综合征文献病例分析
- Author:
Jiejiu LU
1
;
Guangming HUANG
1
;
Chunle LYU
1
;
Taotao LIU
1
Author Information
1. 广西医科大学第一附属医院药学部，南宁 530021
- Publication Type:Journal Article
- Keywords:
Tacrolimus;
Kidney transplantation;
Posterior leukoencephalopathy syndrome;
Drug-related side effects and adverse reactions
- From:
Adverse Drug Reactions Journal
2021;23(5):235-240
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical features of tacrolimus-associated posterior reversible encephalopathy syndrome (PRES) in patients after kidney transplantation.Methods:Relevant databases at home and abroad were searched as of August 2020, and case reports of tacrolimus-associated PRES after kidney transplantation were collected. Clinical information including patient′s basic characteristics, tacrolimus application (such as route of administration, dose, blood concentration, drug combination regimen, etc.), and the occurrence time, clinical manifestation, imaging characteristics, intervention measures, and outcomes of PRES were extracted and analyzed by descriptive statistical method.Results:A total of 16 patients were enrolled in the study, including 7 males and 9 females, aged from 7 to 54 years with a median age of 26 years. Of them, 6 patients were <18 years old and 10 patients were ≥18 years old. Among the 16 patients, 8 received intravenous administration and 8 oral administration. Thirteen patients had records of drug combination regimen and 1, 2, and 3 immunosuppressants were combined in 3, 8, and 2 patients, respectively. PRES occurred from 3 days to 3 months after renal transplantation and 10 patients (62.5%) occurred within 1 month after operation. Eleven of 13 patients who underwent tacrolimus plasma concentrations testing did not exceed the upper limit of the treatment window when PRES occurred. The main symptoms of PRES included convulsions/seizures-like seizures (in 11 patients), visual abnormalities (in 7 patients), persistent headache (in 6 patients), and coma or disturbance of consciousness (in 6 patients). CT and/or magnetic resonance imaging were performed in all 16 patients. Imaging features of cerebral edema or vasogenic cerebral edema were found in 15 patients and the lesions located mainly in occipital lobe (13 patients), parietal lobe (12 patients), and the frontal lobe (8 patients). After discontinuation or reduction of the tacrolimus dose and/or giving symptomatic and supportive treatments for 2-44 days (the median time of 9 days), symptoms subsided in all 16 patients and imaging examination showed cerebral edema, vasogenic cerebral edema, and other lesions subsided in 15 patients.Conclusions:Tacrolimus-associated PRES mostly occurred within 3 months after renal transplantation, which was not related to the route of administration or blood concentration of tacrolimus. The clinical manifestations of tacrolimus-associated PRES were similar to those caused by other factors. After discontinuation of tacrolimus, reduction of drug dose and/or administration of symptomatic treatment, most of the symptoms disappeared quickly and the imaging changes returned to normal.
