Massive pleural effusion in a renal transplant recipient on tacrolimus

Abstract

Fluid and salt retention have been described as a side effect of tacrolimus therapy. We report a case of unexplained massive fluid retention with pleural effusion and ascites in the immediate post-transplant period. The patient recovered immediately on conversion from tacrolimus to sirolimus.

Tacrolimus as a rare cause of pericardial effusion in a renal transplant recipient

“…[ 1 ] Nephrotoxicity manifesting as oliguria, increased serum creatinine, and hyperkalemia has been reported as the major side effect of tacrolimus;[ 2 ] however, fluid and salt retention (with massive pleural effusions and ascites) induced by tacrolimus in the immediate posttransplant period have also been described. [ 3 ]…”

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“…Nevertheless, immunosuppressive agents may cause PE with potentially harmful effects. 17 We believe that further studies are needed to outline the role of immunosuppressive drugs and PE.…”

“…Fluid and sodium retention, hypervolemia, and PE have been reported to occur in the posttransplant period. 17 Mycophenolate mofetil is the morpholino ethyl ester of mycophenolic acid with potent immunosuppressive properties in patients who have had solid-organ transplant procedures. Mycophenolate mofetil has a potential adverse effect for hypervolemia and edema similar to that shown with tacrolimus.…”

When Paranoia Comes with the Treatment: Psychosis Associated with Tacrolimus Use

“…Tacrolimus has been associated with many forms of nephrotoxicity [ 5 ] and neurotoxic adverse reactions. In fact, 40–60% of patients on tacrolimus develop mild-to-moderate neuropsychiatric complaints, such as tremor (one of the first and most common neurologic symptoms is a characteristically fine tremor of the upper extremities), peripheral neuropathy, and anxiety [ 4 , 6 ].…”