[The rescue effect of FK506 in refractory rejection after cardiac transplantation]
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1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Insights
This study details a heart transplant patient experiencing severe cardiac rejection. FK506 effectively resolved rejection by reducing CD8 cells, despite a manageable side effect of bradycardia.
Area of Science:
- Cardiology
- Immunology
- Transplantation Science
Background:
- A patient with dilated cardiomyopathy (NYHA class 4) underwent cardiac transplantation.
- Post-transplant monitoring revealed severe cardiac rejection episodes.
Observation:
- Initial steroid therapy was ineffective for managing severe cardiac rejection.
- OKT3 and Anti-thymocyte globulin successfully resolved the first rejection episode.
- A second severe rejection episode occurred five months post-transplantation, unresponsive to steroids.
Findings:
- Substitution of Cyclosporine with FK506 (0.02 mg/kg/day) led to a decrease in CD8 positive cells.
- FK506 therapy successfully resolved the severe cardiac rejection.
- A transient side effect of bradycardia (heart rate 50/min) was observed with FK506 use.
- Bradycardia was effectively managed by reducing FK506 trough levels to below 8 ng/ml.
Implications:
- FK506 demonstrates efficacy in resolving severe cardiac allograft rejection unresponsive to conventional therapies.
- Careful monitoring and dose adjustment of FK506 are crucial for managing side effects like bradycardia.
- This case highlights FK506 as a potential therapeutic option for refractory cardiac transplant rejection.
Abstract:
The patient with dilated cardiomyopathy (NYHA class 4) under went cardiac transplantation at University of California, Los Angeles. Severe cardiac rejection was revealed one month after the transplantation. Steroid therapy was not effective, the rejection was resolved with OKT3 therapy and Anti-thymocyte globulin. Moreover, severe rejection was seen five months later. Steroid therapy was not effective. Cyclosporine administration was substituted for FK506 (0.02 mg/kg/day). After the induction of FK506, the number of CD8 positive cells decreased and cardiac rejection was successfully resolved. As side effect of FK506, bradycardia with heart rate of 50/min for 4 minutes appeared. However, it was well-controlled when the trough level of FK506 was reduced to less than 8 ng/ml.