Mano A, Nakatani T, Yahata Y, Kato T, Hashimoto S, Wada K, Ishibashi-Ueda H
Department of Emergency and Critical Care Medicine, Tokushima University, Tokushima, Japan.
Transplant Proc. 2009 Nov;41(9):3831-4. doi: 10.1016/j.transproceed.2009.05.040.
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.
他克莫司是一种强效免疫抑制剂，常用于器官移植。然而，其不良反应包括心脏毒性。在此，我们描述了心脏移植后他克莫司诱导的短暂性心肌肥厚。这种肥厚未引起临床症状，但因血浆脑钠肽浓度升高而被发现，并经超声心动图证实。起初，担心发生同种异体移植排斥反应；然而，心肌活检样本仅显示间质水肿和轻度心肌肥厚，未检测到细胞或体液排斥反应。当时他克莫司血药浓度高于平常；因此，降低了他克莫司剂量。降低他克莫司目标浓度后，心肌肥厚完全消退且未复发，超声心动图和心肌活检均证实了这一点。因此，我们得出结论，他克莫司可诱导可逆性心肌肥厚。在接受他克莫司治疗的患者中，应仔细控制血药浓度，并对心脏受累给予高度关注。
