Spallanzani Valentina, Bindi Lucia, Bianco Irene, Precisi Arianna, DeSimone Paolo, Mazzoni Alessandro, Biancofiore Gianni
Transplant Anesthesia and Critical Care Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Immunohematology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Transfus Apher Sci. 2017 Apr;56(2):238-240. doi: 10.1016/j.transci.2017.01.004. Epub 2017 Feb 2.
Immunosuppressive medication dosing errors are not unfrequent and may present a number of challenges to transplant clinicians. Tacrolimus (TAC) is a widely used immunosuppressant with a narrow therapeutic index and potential severe side effects, including neurotoxicity and kidney injury. We herein report a case of 60-year-old woman who underwent deceased-donor liver transplantation at our center and due to inadvertent TAC overexposure was admitted to the Intensive Care Unit because of severe neurologic impairment, kidney injury and arterial hypotension. This case was challenging because TAC is largely bound to erythrocytes, has a high molecular weight, is highly lipophilic, has a high distribution volume and cannot be removed by hemodialysis or plasmapheresis. Based on these considerations, we decided to replace TAC-saturated erythrocytes with blood-bank red cells with the aim to accelerate its clearance. The treatment was effective in decreasing TAC whole blood trough levels within the therapeutic ranges with a significant improvement of the patient's clinical status. Red-blood cell exchange is a potentially safe and effective means of managing severe and symptomatic TAC toxicity.
免疫抑制药物给药错误并不罕见，可能给移植临床医生带来诸多挑战。他克莫司（TAC）是一种广泛使用的免疫抑制剂，治疗指数窄，且有包括神经毒性和肾损伤在内的潜在严重副作用。我们在此报告一例60岁女性患者，她在我们中心接受了已故供体肝脏移植，因TAC意外过量暴露，因严重神经功能损害、肾损伤和动脉低血压入住重症监护病房。该病例具有挑战性，因为TAC主要与红细胞结合，分子量高，高度亲脂，分布容积大，且不能通过血液透析或血浆置换清除。基于这些考虑，我们决定用血库红细胞替代TAC饱和的红细胞，以加速其清除。该治疗有效地将TAC全血谷浓度降至治疗范围内，患者临床状况显著改善。红细胞置换是处理严重且有症状的TAC毒性的一种潜在安全有效的方法。
