Tacrolimus‐Induced Cardiomyopathy in an Adult Renal Transplant Recipient

Abstract

Tacrolimus-induced cardiomyopathy (TICM) is a rare but serious adverse effect of tacrolimus, which has been described primarily in pediatric non-renal transplant recipients. We describe a case of TICM in an adult renal transplant recipient that resulted in allograft dysfunction and multiple hospital admissions for heart failure exacerbation. Prompt and complete reversal of TICM occurred after tacrolimus discontinuation. Although tacrolimus-induced cardiomyopathy is reversible, availability of alternative immunosuppressants is limited, particularly in the setting of renal dysfunction. Available studies and patient-specific factors must be considered when determining an alternative maintenance immunosuppression regimen. We chose to use belatacept as alternative immunosuppression in this patient with TICM. Over the next 3 years, the patient remained free of hospital admissions and acute rejection, and demonstrated superior renal allograft function than was observed before her first heart failure admission. We believe that belatacept is an acceptable alternative to tacrolimus therapy for resolution of TICM.

Hypertrophic cardiomyopathy secondary to tacrolimus therapy in a kidney transplant patient: A case report and focused review of the literature

“…We found 18 articles, consisting of case reports and observational studies, which described hypertrophic cardiomyopathy as an adverse effect to tacrolimus therapy, occurring in a wide age range (Table 1). Although similar cases have been described in patients between the ages of 58 and 62 years, 6,8,12 with hypertrophic cardiomyopathy, 13 and another case described a premature newborn with hypertrophic cardiomyopathy whose mother had received tacrolimus during pregnancy. 14 There were no differences between men and women in the occurrence of tacrolimus-induced cardiomyopathy.…”

“… 5 However, it has also been reported in adult renal, hepatic, cardiac, and small bowel transplant recipients. 6 , 7 , 8 , 9 Hypertrophic cardiomyopathy due to tacrolimus therapy has been catalogued as non‐familial acquired cardiomyopathy by the European Society of Cardiology (ESC), 10 while the American Heart Association classifies it as secondary cardiomyopathy. 11…”

“…Tacrolimus‐induced cardiomyopathy is a rare but important cardiovascular adverse event that has been reported predominantly in pediatric transplant recipients 5 . However, it has also been reported in adult renal, hepatic, cardiac, and small bowel transplant recipients 6‐9 . Hypertrophic cardiomyopathy due to tacrolimus therapy has been catalogued as non‐familial acquired cardiomyopathy by the European Society of Cardiology (ESC), 10 while the American Heart Association classifies it as secondary cardiomyopathy 11…”

Acute right heart failure caused by tacrolimus after renal transplantation: Serial observation by speckle tracking and Doppler echocardiography

“…However, in this case, RV‐FAC and RV global longitudinal strain were reduced in the setting of volume overload. Tacrolimus is known to lead a cardiomyopathy with reduced left ventricular (LV) ejection fraction and LV hypertrophy . Reduction in the RV function and strain could reflect similar myocardial impairment of the RV.…”

Dilated Cardiomyopathy in an Adult Renal Transplant Recipient: Recovery Upon Tacrolimus to Sirolimus Switch: A Case Report

“…Potential direct toxic effect of CNIs on myocardium is not well studied. Previous reports have predominantly described concentric and hypertrophic cardiomyopathy following solid organ transplant [2,3]. Mc Leod et al reported a case of dilated cardiomyopathy following liver transplant which did not recover following Tacrolimus withdrawal [4].…”