2017 Volume 52 Issue 1 Pages 067-072
Although tacrolimus is widely used as an immunosuppressive drug after lung transplantations, there have been few reports on adverse cardiovascular events after lung transplantation. A 36-year-old female underwent a right single-lung transplantation for idiopathic interstitial pneumonia. Intravenous administration of cyclosporine was started just after the transplantation, and it was switched to oral tacrolimus on day 4. On day 10, she suffered from acute rejection and was treated with a dose of tacrolimus and an administration of methylprednisolone for 2 days. On day 12, after the ingestion of tacrolimus, she had chest pain, dyspnea and syncope. Electrocardiography showed ST elevation in the chest leads from V3 to V5 and troponin T rose to 0.114 ng/ml. Coronary angiography showed no stenosis, but it demonstrated a spastic change of coronary arteries after coronary injection of acetylcholine. The tacrolimus concentration on the day of the attack was 11.9 ng/ml, and 15.4 ng/ml and 19.6 ng/ml on the following 2 days, respectively, despite dose reduction: therefore it was suggested that tacrolimus was the factor of the angina attack. Since the next day, she has undergone mechanical ventilation to treat pulmonary edema caused by heart failure for 4 days. She has experienced no angina attacks thereafter and has been quite well for 2 years since the lung transplantation. In summary, we report a patient who suffered from vasospastic angina possibly caused by tacrolimus 10 days after lung transplantation. We should fully consider vasospastic angina a tacrolimus the side effect.
