Abstract
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.
Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
MeSH terms
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Adult
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Calcineurin / adverse effects
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Calcineurin Inhibitors*
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Cholestasis / chemically induced*
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Cholestasis / complications
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Disease Progression
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Fatal Outcome
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Female
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Graft Rejection
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Humans
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Hypertension, Pulmonary / complications
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Hypertension, Pulmonary / surgery*
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Immunosuppressive Agents / adverse effects*
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Immunosuppressive Agents / therapeutic use
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Living Donors
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Lung Transplantation / adverse effects
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Lung Transplantation / methods*
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Methylprednisolone / adverse effects
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Methylprednisolone / therapeutic use
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Pneumonia, Bacterial / complications
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Pneumonia, Bacterial / diagnosis
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Postoperative Complications / diagnosis
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Postoperative Complications / therapy
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Pseudomonas Infections / complications
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Pseudomonas Infections / diagnosis
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Risk Assessment
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Sirolimus / adverse effects
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Sirolimus / therapeutic use
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Tacrolimus / adverse effects
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Tacrolimus / therapeutic use
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Transplantation Immunology
Substances
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Calcineurin Inhibitors
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Immunosuppressive Agents
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Calcineurin
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Sirolimus
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Tacrolimus
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Methylprednisolone