title: Impairment of the blood-brain barrier can result in tacrolimus-induced reversible leucoencephalopathy following heart transplantation.
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, Ludwig-Maximilians-University, Grosshadern, Munich, Germany. dr4maus1@aol.com
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Jan
authors.initials: J
authors.lastname: Groetzner
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.forename: Markus
authors.initials: M
authors.lastname: Mueller
authors.forename: Peter
authors.initials: P
authors.lastname: Landwehr
authors.forename: Peter
authors.initials: P
authors.lastname: Ueberfuhr
authors.forename: Roland
authors.initials: R
authors.lastname: Bruning
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
mesh_terms: 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*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus