Successful conversion from cyclosporine to tacrolimus for gastric motor dysfunction in a lung transplant recipient.
BACKGROUND
Conversion after transplantation from cyclosporine to tacrolimus is often performed because of recurrent acute/chronic rejection or unacceptable side effects such as nephrotoxicity, arterial hypertension, and cosmetic disorders. Although gastrointestinal discomfort is often reported after transplantation, it is usually not considered a sufficient reason for conversion, although tacrolimus seems beneficial with regards to gastric motor activity in renal transplant patients.


METHODS
A lung transplantation was performed in a 41-year-old woman with alpha-1 antitrypsin deficiency emphysema. Because the patient presented severe symptoms of nausea, vomiting, and dyspepsia, without obvious endoscopic explanation, that resulted in highly variable cyclosporine trough levels, she was converted from cyclosporine to tacrolimus.


RESULTS
After conversion, dyspepsia, nausea, and vomiting resolved. Neurological complications caused by a transient high trough level of tacrolimus resolved completely upon dose reduction with tacrolimus trough levels remaining very stable afterwards.


CONCLUSIONS
Tacrolimus may be the immunosuppressant of choice after solid organ transplantation in patients with problems related to gastric motor dysfunction.
Department of Respiratory Disease, University Hospital Gasthuisberg, Leuven, Belgium. geert.verleden@ uz.kuleuven.ac.be
Geert M
GM
Verleden
Tatiana
T
Besse
Bart
B
Maes
D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000009:adverse effects*; D013272:Stomach Diseases / Q000139:chemically induced / Q000517:prevention & control*; D016559:Tacrolimus / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus