Impairment of the blood-brain barrier can result in tacrolimus-induced reversible leucoencephalopathy following heart transplantation.
Fatal leucoencephalopathy is a rare calcineurin inhibitor-related complication, especially in kidney and liver transplant recipients. The only means of clinical management reported so far is the discontinuation or reduction in the calcineurin inhibitor. We herein report a case of a 37-yr-old male who developed leucoencephalopathy 12 wk after heart transplantation and recovered after stabilization of metabolism and arterial blood pressure. The findings in this case support the hypothesis that tacrolimus-associated neurotoxicity is severely increased by an impairment of the blood-brain barrier. Withdrawal of tacrolimus was not necessary while other causes of endothelial injury were treated successfully.
Kaczmarek
Ingo
I
Department of Cardiac Surgery, Ludwig-Maximilians-University, Grosshadern, Munich, Germany. dr4maus1@aol.com
Groetzner
Jan
J
Meiser
Bruno
B
Mueller
Markus
M
Landwehr
Peter
P
Ueberfuhr
Peter
P
Bruning
Roland
R
Reichart
Bruno
B
D000328:Adult; D001812:Blood-Brain Barrier / Q000187:drug effects*; D001927:Brain Diseases / Q000139:chemically induced*; D065095:Calcineurin Inhibitors; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D016559:Tacrolimus / Q000009:adverse effects*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus