PDF(Pubmed)
Abstract：
In this editorial, we talk about a compelling case focusing on posterior reversible encephalopathy syndrome (PRES) as a complication in patients undergoing liver transplantation and treated with Tacrolimus. Tacrolimus (FK 506), derived from Streptomyces tsukubaensis, is a potent immunosuppressive macrolide. It inhibits T-cell transcription by binding to FK-binding protein, and is able to amplify glucocorticoid and progesterone effects. Tacrolimus effectively prevents allograft rejection in transplant patients but has adverse effects such as Tacrolimus-related PRES. PRES presents with various neurological symptoms alongside elevated blood pressure, and is primarily characterized by vasogenic edema on neuroimaging. While computed tomography detects initial lesions, magnetic resonance imaging, especially the Fluid-Attenuated Inversion Recovery sequence, is superior for diagnosing cortical and subcortical edema. Our discussion centers on the incidence of PRES in solid organ transplant recipients, which ranges between 0.5 to 5 +ACU-, with varying presentations, from seizures to visual disturbances. The case of a 66-year-old male status post liver transplantation highlights the diagnostic and management challenges associated with Tacrolimus-related PRES. Radiographically evident in the parietal and occipital lobes, PRES underlines the need for heightened vigilance among healthcare providers. This editorial emphasizes the importance of early recognition, accurate diagnosis, and effective management of PRES to optimize outcomes in liver transplant patients. The case further explores the balance between the efficacy of immunosuppression with Tacrolimus and its potential neurological risks, underlining the necessity for careful monitoring and intervention strategies in this patient population.
摘要：
在这篇社论中，我们讨论了一个令人信服的案例，重点是后部可逆性脑病综合征（PRES），这是接受肝移植并接受他克莫司治疗的患者的并发症。他克莫司(FK506),来自筑鹿链霉菌，是一种有效的免疫抑制大环内酯。它通过结合FK结合蛋白抑制T细胞转录，并能增强糖皮质激素和孕酮的作用。他克莫司可有效预防移植患者的同种异体移植排斥反应，但具有不利影响，例如他克莫司相关的PRES。PRES表现出各种神经症状以及血压升高，在神经影像学上主要表现为血管源性水肿。当计算机断层扫描检测到初始病变时，磁共振成像，尤其是流体衰减反转恢复序列,对诊断皮质和皮质下水肿具有优势。我们的讨论集中在实体器官移植受者中PRES的发生率，范围在0.5到5+ACU-之间，随着不同的介绍，从癫痫到视觉障碍。一名66岁男性肝移植后的病例强调了与他克莫司相关的PRES相关的诊断和管理挑战。在顶叶和枕叶放射学上明显，PRES强调需要提高医疗保健提供者的警惕。这篇社论强调了及早认识的重要性,准确诊断,和PRES的有效管理，以优化肝移植患者的预后。该病例进一步探讨了他克莫司免疫抑制疗效与其潜在神经系统风险之间的平衡,强调在这一患者人群中仔细监测和干预策略的必要性。
