Сase Study of Hepato-Renal Failure in a Patient After Orthotopic Heart Transplantation

Abstract

Introduction. Heart transplantation remains the only radical treatment for end-stage heart failure (HF). Liver and / or renal dysfunction is common in patients with HF, which is also exacerbated by the use of artificial circulation and immunosuppressive therapy, and leads to postoperative complications and mortality. Case description. Patient P., 49 years old, after orthotopic heart transplantation was admitted to the intensive care unit (ICU) with signs of multiple organ failure. Graft rejection syndrome was suspected, but was not confirmed after the detailed clinical and laboratory examinations and according to the myocardial biopsy. Because of severe renal and hepatic insufficiency, patient at the ICU started to receive hemodiaultrafiltration with a flow of 190 ml/min; ultrafiltration – 100 ml/h. The condition, that developed was due to the direct effect of tacrolimus as the patient had a critically high plasma concentration of this drug (> 30 ng / ml) after the standard recommended postoperative dose (0.2 mg / kg per day). According to the literature, the elimination of the tacrolimus is provided by the liver, with microsomal cytochrome P450 3A4. Thus, the patient most likely had a failure of hepatic metabolism. Conclusion: Because of the systemic toxicity of tacrolimus, it is important to monitor its concentration after the first dose. Diagnosis of metabolic disorders at an early stage will prevent further systemic toxicity of tacrolimus. Efferent methods at ICU are the important tools for the correction of hepatic and renal insufficiency throughout toxic effects of tacrolimus.