Reversal of tacrolimus‐related hypertrophic cardiomyopathy after conversion to rapamycin in a pediatric liver transplant recipient

Abstract

Tacrolimus (Tac)-related hypertrophic cardiomyopathy (HCM) has been reported to be an unusual but serious complication affecting pediatric patients after solid organ transplantation. Herein, we present a case of young liver transplant recipient with Tac-induced HCM, treated by discontinuation of Tac followed by conversion to rapamycin (Rap). Our case report points out the potential but rather low risk of HCM during Tac immunosuppression in pediatric liver transplants and demonstrates that replacement of calcineurin inhibitors with mammalian target of Rap (mTOR) inhibitors may be an efficacious therapeutic tool to effect regression of established cardiac hypertrophy.

Tacrolimus‐Induced Cardiomyopathy in an Adult Renal Transplant Recipient

“…Previous reports of TICM have demonstrated the reversibility or regression of this adverse effect through discontinuation of tacrolimus and use of another immunosuppressive agent, such as cyclosporine or sirolimus . The key differences in the mechanisms of action for both cyclosporine and sirolimus compared to tacrolimus help to explain the observed improvements in cardiac abnormalities in these reports.…”

“…Outside of the commonly recognized adverse effects of tacrolimus, such as nephrotoxicity, neurotoxicity, and hyperglycemia, tacrolimus has been associated with cardiomyopathy. The cardiotoxic effects of tacrolimus have been most commonly characterized as obstructive or concentric hypertrophic cardiomyopathy and primarily described in pediatric transplant recipients . Although the mechanism of TICM has not been fully elucidated, theories exist.…”

“…The description of TICM in the literature is limited, and the majority of studies describe pediatric liver and/or small bowel transplant recipients (Table ) . Few cases of TICM have been described following renal transplantation .…”

Patient after renal transplantation with syncope: Role of echocardiography in upright position

“…In our patient, LV hypertrophy was larger, and a mild LVOT gradient was present even in the supine position, increasing dramatically when changing to the upright position. This may be due to LV hypertrophy as a complication of hypertension, previous uremic disease, or medications like steroids and tacrolimus . However, the leading factor seems to be LV hypercontractility after beta‐blocker discontinuation.…”

Target of Rapamycin (TOR)–Based Therapy for Cardiomyopathy: Evidence From Zebrafish and Human Studies

“…In addition to the studies in the renal transplant patients, a case report on the management of a pediatric liver transplant patients (Turska-Kmiec, et al 2007) provided one of the earliest clinical indications of the potential of TOR inhibition in the reduction of cardiac hypertrophy by showing that the replacement of tacrolimus with rapamycin reversed tacrolimus-induced hypertrophic cardiomyopathy.…”