Cyclosporine-induced pericardial effusion after cardiac transplantation

Abstract

In the last 5 years, there has been a significant proliferation in the number of centers in which orthotopic cardiac transplantation is performed. This has been attributed to better surgical management, patient selection criteria and the introduction of cyclosporine as the immunosuppressant of choice. 1 Initially, it was hoped that cyclosporine would prevent the problems of sudden, catastrophic rejection, development of a Cushingoid appearance and other complications of high-dose steroid therapy. It was also hoped that by monitoring drug levels and titrating the dose, the incidence and severity of rejection would decrease, the length of hospitalization in the immediate postoperative period would decrease and both short-term and long-term survival would increase. 2 It soon became apparent, however, that long-term cyclosporine immun osuppression is associated with severe systemic hypertension and progressive chronic renal insufficiency. 3 Both complications of cyclosporine therapy may lead to the necessity of decreasing the dose of cyclosporine, a readjustment of immunosuppressive protocols to low-dose triple drug therapy (azathioprine, prednisone and cyclosporine) and even the necessity of withdrawing cyclosporine. 4 Less frequently, we have observed significant pericardial effusions in patients who have received cardiac allografts. We will discuss our observations of pericardial disease in the orthotopic cardiac recipient maintained on cyclosporine.