Unmasking Pres: A Nationwide Analysis of Incidence and Outcomes in Kidney Transplantation

Document Type

Conference Proceeding

Publication Date

5-1-2026

Publication Title

Am J Kidney Dis

Keywords

Urology & Nephrology

Abstract

Calcineurin inhibitors, essential in kidney transplant immunosuppression, are associated with posterior reversible encephalopathy syndrome (PRES)-a clinicoradiologic syndrome characterized by seizures, encephalopathy, and visual disturbances. The incidence and outcomes of PRES in kidney transplant recipients compared to non-transplant patients remain unclear. We used the National Inpatient Sample (2016–2021) to assess PRES incidence, demographics, and in-hospital outcomes by kidney transplant status. Multivariable logistic regression identified predictors of PRES and mortality. Among 65,225 weighted PRES hospitalizations, PRES incidence was significantly higher in kidney transplant recipients (0.15%) compared to non-transplant patients (0.036%), representing a 4.2-fold increase. Transplant recipients with PRES were younger (median age 47 vs. 58 years, p<0.05), had longer hospital stays (12.1 vs. 10.3 days, p=0.033), and were less likely to be female (52.9% vs. 69.9%, p<0.001), with comparable hospitalization charges ($146,509 vs. $134,386, p=0.38). They had higher rates of hypertension (93.4% vs. 83.3%, p<0.001) but lower rates of smoking and obesity. Kidney transplant history was independently associated with PRES (OR 2.32, 95% CI 2.07–2.66, p<0.0001), but not with in-hospital mortality (OR 0.83, 95% CI 0.44 1.58, p=0.567). Predictors of increased mortality included older age (OR 1.02, 95% CI 1.02–1.03, p<0.0001), heart failure (OR 1.52, 95% CI 1.25 1.85, p<0.0001), and atrial fibrillation (OR 1.62, 95% CI 1.29–2.03, p<0.0001). Kidney transplant recipients are at higher risk of PRES, with distinct demographic and clinical features, yet without increased in-hospital mortality. Early recognition and aggressive management of modifiable risks, particularly hypertension, may reduce PRES burden in this population.

Volume

87

Issue

5

First Page

S201

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