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Fixed dilated pupils and tacrolimus toxicity in paediatric liver transplant patients

Claire Westrope1, Helen Rowlands, Kevin Morris

  • 1Paediatric Intensive Care Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK. claire@westropes.co.uk

Pediatric Transplantation
|February 18, 2010
PubMed

Insights

High tacrolimus levels in children after liver transplants can cause fixed dilated pupils. This post-operative complication is linked to drug concentrations exceeding 30 ng/mL.

Area of Science:

  • Pediatric Surgery
  • Pharmacology
  • Ophthalmology

Background:

  • Tacrolimus is an immunosuppressant crucial for preventing organ rejection in pediatric transplant recipients.
  • Monitoring tacrolimus levels is essential to balance efficacy and toxicity, especially in pediatric patients.

Observation:

  • A case series identified four pediatric patients presenting with fixed dilated pupils post-liver or liver-small bowel transplantation.
  • This neurological sign correlated with elevated serum tacrolimus concentrations, surpassing 30 nanograms/millilitre.

Findings:

  • Fixed dilated pupils represent a potential, albeit rare, clinical manifestation of tacrolimus toxicity in pediatric transplant patients.
  • The observed association highlights the importance of vigilant neurological monitoring in the immediate post-operative phase.

Implications:

  • Early recognition of fixed dilated pupils may prompt timely tacrolimus level assessment and dose adjustment.
  • This finding contributes to a better understanding of the neuro-ophthalmic side effects of tacrolimus in pediatric transplantation.

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