title: Quinolone-related Achilles tendinopathy in heart transplant patients: incidence and risk factors.
abstract: BACKGROUND
  A high incidence of Achilles tendinopathy--tendinitis or rupture--has been observed after quinolone treatment in lung and kidney transplant patients. In the absence of relevant published data, we aimed to determine its incidence, clinical features, risk factors and outcome among heart graft recipients.
  
  
  METHODS
  We studied the clinical records of all adult heart transplant patients who were prescribed quinolones at our center between August 1995 and September 2006. Achilles tendinopathy had been diagnosed clinically, with ultrasound assessment when necessary. In all cases, quinolone treatment had been terminated upon diagnosis of tendinopathy.
  
  
  RESULTS
  During this period, quinolones had been given on 242 occasions to 149 heart transplant patients (33 women, 116 men). Achilles tendinopathy developed on 14 occasions (5.8%; 95% confidence interval: 2.8% to 8.7%), affecting 13 men and 1 woman (mean age: 62 years). Three cases involved tendon rupture, and bilateral tendinopathy was present in 8 cases. The median time between the start of treatment and onset of symptoms was 2.5 days, with 12 patients being asymptomatic 2 months after drug withdrawal. Independent risk factors for tendinopathy were renal dysfunction (p = 0.03) and increased time between transplantation and treatment (p = 0.005). Incidence was not influenced by the type, dose or previous administration of quinolones, or by the immunosuppressive regimen.
  
  
  CONCLUSIONS
  Quinolone-related Achilles tendinopathy is frequent among heart transplant patients, especially in the presence of renal dysfunction or lengthy post-transplantation survival. If no alternative anti-bacterial therapy is available for high-risk patients, close clinical surveillance should be warranted.
authors.affiliation: Heart Transplant Unit, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain. blargesbueno@hotmail.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.forename: María G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.forename: María J
authors.initials: MJ
authors.lastname: Paniagua-Martín
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.forename: Carmen
authors.initials: C
authors.lastname: Naya
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.forename: Pablo
authors.initials: P
authors.lastname: Piñón-Esteban
authors.forename: Raquel
authors.initials: R
authors.lastname: Marzoa-Rivas
authors.forename: Pablo
authors.initials: P
authors.lastname: Pazos-López
authors.forename: Guillermo C
authors.initials: GC
authors.lastname: Cursack
authors.forename: José J
authors.initials: JJ
authors.lastname: Cuenca-Castillo
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D000125:Achilles Tendon; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015363:Quinolones / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D052256:Tendinopathy / Q000139:chemically induced / Q000453:epidemiology*
chemical_list: D015363:Quinolones