Do you make adjustments to the immunosuppressive regimen for kidney transplant recipients on tacrolimus who develop posterior reversible encephalopathy syndrome (PRES)?  

This is an uncommon situation but when it occurs I hold the Tacrolimus for a few days and resume at a low dose aiming for levels that are as low as deemed safe immunologically (typically 4-6). The cases of PRES I have seen have occured with higher Tac levels.  

Agree, fortunately it is a rare occurrence. There is some association with low cholesterol and the development of PRES. When I have seen it, I typically change the calcineurin inhibitor from tacrolimus to cyclosporine, though this can also be seen with cyclosporine. In some cases I have converted fr...