Asymmetric cardiac hypertrophy at autopsy in patients who received FK506 (tacrolimus) or cyclosporine a after liver transplant

Background. Cardiotoxicity has been described in a group of pediatric patients receiving FK506 as a part of immunosuppression for orthotopic liver transplantation (OLT). Information regarding the cardiac pathology related to this agent is limited. Methods. Among the first 975 liver transplants at our institution (1985-1995), autopsy hearts were available for 19 patients (14 adults and 5 children) who received FK506 for a minimum of 1 week prior to death. Patients with excessive alcohol use, significant coronary artery disease, valvular disease, diabetes mellitus, or pretransplant hypertension were excluded from analysis. We compared heart weight (HW), heart weight-to-body weight ratio (HW/BW), ventricular septal (VS) thickness with left ventricular (LV) thickness ratio (VS/LV), and cardiac histologic findings of 12 OLT patients (7 adults, 5 children) who received FK506 with a group of 75 OLT patients (48 adults, 27 children) who received Cyclosporine (CsA) and 20 (10 adults, 10 children) age-comparable control patients without OLT. Results. All FK506 and CsA children and adults had cardiomegaly by HW, HW/BW (P_{FK506 peds}<0.024, P_{CsA peds}<0.028, P_{FK506 adults}<0.017, P_{CsA adults}<0.006) and increased VS/LV ratio 1.25_FK506 (P<0.006) and 1.23_CsA (P<0.006)(pediatric) and 1.09_FK506 (P<0.0122) and 1.21_CsA (P<0.0009) (adults), compared with control. Conclusion. Cardiomegaly by HW, HW/BW, and his. tology was uniformly present in both FK506 and CsA adult and pediatric OLT patients at autopsy. A relatively greater VS hypertrophy than LV was present in both transplant groups. We found no gross or histologic cardiac finding that separated these FK506 from CsA OLT patients at autopsy.