tacrolimus and Inappropriate-ADH-Syndrome

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an extremely rare cause of hyponatremia post-liver transplantation. A 15-year-old Japanese girl with recurrent cholangitis after Kasai surgery for biliary atresia underwent successful living donor liver transplantation. Peritonitis due to gastrointestinal perforation occurred. Hyponatremia gradually developed but improved after hypertonic sodium treatment. One month later, severe hyponatremia rapidly recurred. We considered the hyponatremia's cause as SIADH. We suspected that tacrolimus was the disease's cause, so we used cyclosporine instead, plus hypertonic sodium plus water intake restriction, which improved the hyponatremia. Symptomatic hyponatremia manifested by SIADH is a rare, serious complication post-liver transplantation.

Topics: Adolescent; Cholangitis; Diagnosis, Differential; Female; Humans; Hyponatremia; Immunosuppressive Agents; Inappropriate ADH Syndrome; Liver Transplantation; Postoperative Complications; Tacrolimus; Vasopressins

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an important electrolyte abnormality that can occur following allogeneic stem cell transplantation. We herein report the case of a 20-year-old man who developed SIADH three weeks after undergoing cord blood transplantation. Tacrolimus administration was suspected to be a cause of the disorder. In addition to restricting water intake and administering hypertonic sodium, the tacrolimus dosage was reduced, resulting in alleviation of SIADH. Therefore, tacrolimus should be recognized as an important, albeit rare, cause of drug-induced SIADH, even in patients with tacrolimus blood concentrations within the normal range. We believe that dose reduction, not discontinuation, is an effective strategy.

Topics: Cord Blood Stem Cell Transplantation; Humans; Immunosuppressive Agents; Inappropriate ADH Syndrome; Male; Tacrolimus; Transplantation, Homologous; Young Adult

We describe the first reported case of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) induced by low-dose tacrolimus in a patient with autoimmune disease. A 41-year-old man with systemic lupus erythematosus (SLE) developed hyponatremia induced by SIADH after administration of tacrolimus (0.06 mg/kg per day). In this case, the hyponatremia promptly resolved upon withdrawal of tacrolimus. This case strongly suggests that SIADH is a potentially important complication of tacrolimus administration, irrespective of dosage, and should be borne in mind whenever the drug is used.

Topics: Adult; Humans; Hyponatremia; Immunosuppressive Agents; Inappropriate ADH Syndrome; Lupus Erythematosus, Systemic; Male; Tacrolimus; Withholding Treatment

Topics: Adult; Bone Marrow Transplantation; Female; Graft vs Host Disease; Humans; Hyponatremia; Inappropriate ADH Syndrome; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Tacrolimus; Transplantation, Homologous