title: Arteritis and increased intracellular calcium as a possible mechanism for tacrolimus-related cardiac toxicity in a pediatric transplant recipient.
abstract: We recently reported partially to wholly reversible hypertrophic cardiomyopathy, including severe hypertrophic obstructive cardiomyopathy, as a side effect in pediatric transplant recipients receiving tacrolimus immunosuppression. This seemed to be dose related. We describe a pediatric patient receiving tacrolimus who died 3 weeks after liver/bowel transplantation. Postmortem findings revealed arteritis of cardiac arteries and extensive calcification of cardiac tissue suggesting a possible mechanism of tacrolimus cardiac toxicity. This is consistent with recent reports of tacrolimus increasing calcium release into the sarcoplasmic reticulum of cardiac and striated muscle.
authors.affiliation: Department of Paediatrics, Children's Hospital of Western Ontario, University of Western Ontario, London, Canada.
authors.forename: P R
authors.initials: PR
authors.lastname: Atkison
authors.forename: G I
authors.initials: GI
authors.lastname: Joubert
authors.forename: C
authors.initials: C
authors.lastname: Guiraudon
authors.forename: R
authors.initials: R
authors.lastname: Armstrong
authors.forename: W
authors.initials: W
authors.lastname: Wall
authors.forename: S
authors.initials: S
authors.lastname: Asfar
authors.forename: D
authors.initials: D
authors.lastname: Grant
mesh_terms: D001167:Arteritis / Q000139:chemically induced* / Q000378:metabolism*; D002118:Calcium / Q000378:metabolism*; D002312:Cardiomyopathy, Hypertrophic / Q000139:chemically induced / Q000209:etiology*; D002352:Carrier Proteins / Q000378:metabolism; D002675:Child, Preschool; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000633:toxicity; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D012519:Sarcoplasmic Reticulum / Q000737:chemistry; D016559:Tacrolimus / Q000378:metabolism / Q000494:pharmacology* / Q000633:toxicity; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D002352:Carrier Proteins; D007166:Immunosuppressive Agents; D002118:Calcium; D016559:Tacrolimus