American Society for Peripheral Nerve

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Role of Tacrolimus In Return of Hand Function after Lower Trunk Brachial Plexus Injury in a Lung Transplantation Patient: a Case Report
Mana Saffari, MD1, Meiwand Bedar, MD2, Christopher Arendt, R.Ph.1, Allen T. Bishop, MD3, Robert J. Spinner, MD4 and Alexander Y. Shin, MD5, (1)Mayo Clinic, Rochester, MN, (2)Mayo Clnic, Rochester, MN, (3)Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, (4)Neurosurgery, Mayo Clinic, Rochester, MN, (5)Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, MN



Background: Tacrolimus, also known as FK506, has been the cornerstone of immunosuppressive therapy and has been used for the prevention of allograft rejection after solid organ transplantation for over two decades. There are many controversies regarding its use in peripheral nerve injuries as both neurotoxic and neuroregenerative effects have been reported.

Case description: We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a sternotomy induced left lower trunk brachial plexus injury with unusual improvement of lower trunk innervated hand function. The lower trunk injury with resultant left hand paralysis had developed after his sternotomy for his bilateral lung allotransplantation 18 months ago. The electromyogram (EMG) and magnetic resonance imaging (MRI) of the brachial plexus confirmed severe complete left lower trunk plexopathy and moderate diffuse T2 hyperintensity of the elements of the brachial plexus, without any focal mass or evidence of an active process at the time. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Physical examination at 18 months demonstrated unusual excellent grip pattern and full opposition of his thumb with slight claw deformity of his ulnar two digits.

Conclusions: While the neurotoxic effects of tacrolimus are more emphasized, recent insights show that tacrolimus may also have neuroprotective properties. This recovery is the first to be reporting such an unusual recovery after BPI and is most likely as a result of the low dose of tacrolimus treatment.


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