Calcineurin inhibitor-related cholestasis complicating lung transplantation.
Hepatotoxicity, including cholestasis, is a rare but significant complication of treatment with calcineurin inhibitors. Timely life-saving therapy with revision of immunosuppression is mandatory. A 43-year-old woman with pulmonary hypertension was found to have severe cholestasis (serum bilirubin up to 35 mg/dL) after a living-donor lobar lung transplantation. Calcineurin-inhibitor cholestasis markedly improved after withdrawal of the calcineurin inhibitor, initiation of sirolimus, and interleukin-2 receptor blockade. Awareness of the diagnostic criteria of this rare posttransplant complication is important to initiate timely therapy.
Oto
Takahiro
T
Department of Thoracic Surgery, Okayama University Hospital, Okayama 700-8558, Japan. oto@md.okayama-u.ac.jp
Okazaki
Mikio
M
Takata
Ken
K
Egi
Moritoki
M
Yamane
Masaomi
M
Toyooka
Shinichi
S
Sano
Yoshifumi
Y
Snell
Gregory I
GI
Goto
Keiji
K
Miyoshi
Shinichiro
S
D000328:Adult; D019703:Calcineurin / Q000009:adverse effects; D065095:Calcineurin Inhibitors; D002779:Cholestasis / Q000139:chemically induced* / Q000150:complications; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019520:Living Donors; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011552:Pseudomonas Infections / Q000150:complications / Q000175:diagnosis; D018570:Risk Assessment; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use; D014181:Transplantation Immunology
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D019703:Calcineurin; D020123:Sirolimus; D016559:Tacrolimus; D008775:Methylprednisolone