The impact of calcineurin inhibitors on coronary artery spasm — costs of effective immunosuppression

Abstract

Calcineurin inhibitors (CNI) are the milestone in transplantation. A significant decrease in acute re­jection episodes prevalence and the improvement of the first year kidney graft survival was observed in CNI treated recipients. As this particular group of patients is at a great risk of cardiovascular com­plications following transplantation procedure it is particularly important to pay attention to all possible side effects of these drugs. Such effects include arterial hypertension, diabetes and hyperlipidemia. Apart from classical risk factors due to chronic kid­ney disease and CNI, a cardiospasm is a possible, although not common, consequence of CNI use. Coronary artery spasm, resembling a variant angina pectoris, leads to acute myocardial ischemia. The pathophysiology of coronary artery spasm could be the same as in the case of CNI acute nephrotoxic­ity previously reported in literature. There are some case reports and several animal studies on vascular smooth muscle cell contraction and endothelial dys­function in various vascular beds such as coronary and cerebral arteries due to CNI use. Endothelin, renin–angiotensin system, prostacycline, but also innate immunity mechanism could be blamed for unfavourable outcomes in some of the subjects. This paper hopefully adds a piece to the CNI side effects puzzle.