Posterior reversible encephalopathy syndrome in child patient after liver transplantation from donation after cardiac death: report of one case and literature review

Objective To investigate the diagnosis and treatment of posterior reversible encephalopathy syndrome (PRES) in a child patient after liver transplantation from donation after cardiac death (DCD). Methods Clinical data of a child undergoing liver transplantation in the First People's Hospital of Foshan on July 5, 2018 were retrospectively analyzed. The 4.5-year-old male recipient was complicated with liver cirrhosis in decompensation after surgery of congenital biliary atresia. The DCD donor was a boy aged 6 years old. The informed consent of the patient were obtained and the local ethical committee approval was received. The child underwent orthotopic liver transplantation on July 5, 2018. Tacrolimus combined with hormone immunosuppression was delivered postoperatively. The diagnosis and treatment of postoperative cerebral complications were observed. Results At postoperative 3 d, the child developed convulsion. At postoperative 1 week, the child presented with dysphoria and right hemiplegia. CT, MRI and CT angiography (CTA) of demonstrated acute left cerebral infarction, right cerebral hemorrhage and cerebral vasculitis. Diagnosis of PRES was considered. Tacrolimus was replaced with sirolimus. Comprehensive treatments was delivered to correct coagulation function, hypertension, dehydration, etc. The syndrome of cerebral complications were gradually improved and the patient was discharged at 42 d after operation. After discharge, the child received hyperbaric oxygen therapy. The speech function and cognitive capability were steadily restored and the right limb hemiplegia was gradually mitigated. Until the date of paper submission, the muscle strength of the right upper and lower limbs was restored to Grade Ⅱ. Conclusions Postoperative PRES occurs all of a sudden with severe condition and complex pathogenesis in the pediatric recipient after liver transplantation. Timely adjustment of immunosuppressive therapy and symptomatic treatments play a key role in the treatment of PRES. Key words: Liver transplantation; Child; Postoperative complications; Cerebral hemorrhage; Cerebral infarction