Reversible Myocardial Hypertrophy Induced by Tacrolimus in a Pediatric Heart Transplant Recipient: Case Report

• Published in: Transplantation proceedings Vol. 41; no. 9; pp. 3831 - 3834
• Main Authors: Mano, A, Nakatani, T, Yahata, Y, Kato, T, Hashimoto, S, Wada, K, Ishibashi-Ueda, H
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2009; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Biopsy; Cardiomegaly - chemically induced; Cardiomyopathy, Dilated - surgery; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Graft Rejection - chemically induced; Graft Rejection - pathology; Heart Transplantation - immunology; Heart Transplantation - pathology; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Medical sciences; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - adverse effects; Tacrolimus - blood; Tacrolimus - therapeutic use; Tissue, organ and graft immunology; Treatment Outcome; Human; Heart; Pediatrics; Calcineurin inhibitor; Lactone; Transplantation; Homotransplantation; Macrolide; Case study; Immunomodulator; Medicine; Treatment; Tacrolimus; Surgery; Myocardium; Graft; Circulatory system; Protein synthesis inhibitor; Immunosuppressive agent; Antibacterial agent; Child; Hypertrophy
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.05.040

Abstract Tacrolimus is a potent immunosuppressant that is frequently used in organ transplantation. However, adverse effects include cardiac toxicity. Herein we describe transient myocardial hypertrophy induced by tacrolimus after heart transplantation. The hypertrophy caused no clinical symptoms but was noted because of elevation of plasma brain natriuretic peptide concentration and confirmed at echocardiography. Initially, allograft rejection was feared; however, myocardial biopsy samples revealed only interstitial edema and mild myocardial hypertrophy; neither cellular nor humoral rejection was detected. The blood tacrolimus concentration was higher than usual at that time; thus, tacrolimus dosage was reduced. Myocardial hypertrophy completely resolved upon reducing the target concentration of tacrolimus and did not recur, as confirmed at echocardiography and myocardial biopsy. Thus, we conclude that tacrolimus induces reversible myocardial hypertrophy. In patients receiving tacrolimus therapy, blood concentration should be carefully controlled and extreme attention paid to cardiac involvement.