ABSTRACT: Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by seizures, encephalopathy, visual disturbances, and headache, often occurring in the context of hypertension and immunosuppressive therapy after solid organ transplantation. Although classically presenting with vasogenic edema in the parieto-occipital regions, atypical patterns may also occur. Here we report our experience with a case of cyclosporine-related PRES after liver transplant and summarize PRES clinical features through a literature review.
The case was a 53-year-old man who received a deceased donor liver transplant. His initial immunosuppressive therapy comprised cyclosporine/mycophenolate mofetil/prednisolone. Five months after transplantation, he was admitted to our center with altered mental status. The patient was diagnosed with PRES based on neurological symptoms and neuroimaging findings and recovered after switching from cyclosporine to everolimus. In addition, the lowering of blood pressure with drugs reported in the literature for use in PRES proved to be effective but challenging, requiring the use of multiple agents and only slowly leading to adequate control of hypertensive peaks. Nonetheless, hypertension management and supportive therapy allowed for a complete neurological recovery of the patient.
In conclusion, cyclosporine-associated PRES has a generally favorable prognosis with early diagnosis and prompt treatment, including altering or discontinuing CNIs and controlling blood pressure. CNI-associated PRES should be considered in patients exhibiting acute neurological symptoms after transplantation. Early diagnosis and immediate treatment are critical for a favorable prognosis.

ABSTRACT: Abstract. Biliary strictures represent one of the most common complications after liver transplantation, occurring in 10-30% of recipients and significantly affecting patient quality of life and graft function. Combined hybrid approaches are increasingly widespread in contemporary practice.
Objective: To present a case series of successful application of combined methods for biliary stricture management in patients after liver transplantation and to analyze the efficacy and safety of these approaches.
Methods: A prospective observational study of three female patients (median age 57.0±7.8 years) after orthotopic liver transplantation with biliary strictures was conducted. All underwent a combined procedure using the rendezvous technique, integrating percutaneous transhepatic and endoscopic approaches with biliary stent placement.
Results: Technical success was achieved in 100% of cases (3/3). Clinical success with bilirubin reduction >50% was registered in all patients (3/3, 100%). Total bilirubin decreased from 71.3±22.8 μmol/L to 58.2±18.5 μmol/L by day 7 and to 32.4±8.6 μmol/L by day 30. No serious complications were registered (0/3, 0%). Mean hospitalization was 5.3±1.5 days (range 4-7 days). Mean procedure duration was 85±15 minutes.
Conclusion: The combined method demonstrated high technical feasibility (100%), clinical efficacy (100%), and a favorable safety profile with no serious complications, showing particular effectiveness in recurrent strictures. This approach can be considered as a promising alternative to isolated interventions in treating complex anastomotic biliary strictures.