Abstract: FR-PO1224
Unexplained Recurrent Pericardial Effusion in an Organ Transplant Recipient: Think of Zebras
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Ruiz, Brian, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
- Shaw, Kevin Thomas, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
- Sureshkumar, Kalathil K., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
Introduction
Pericardial effusion in an organ transplant recipient could be of infectious, inflammatory, immunologic or neoplastic etiology. There are rare reports of pericardial effusion related to cyclosporine use in cardiac and stem-cell transplant recipients. We present a case of pericardial effusion thought to be from an idiosyncratic reaction to cyclosporine in a liver transplant recipient.
Case Description
A 68-year-old male underwent orthotopic liver transplantation for MASH cirrhosis. He received induction with methylprednisolone followed by cyclosporine/mycophenolic acid-based immunosuppression and standard infection prophylaxis. His post-operative course was complicated by acute kidney injury requiring maintenance hemodialysis. Eight months post-transplant, patient was found to have a large pericardial effusion without tamponade on echocardiogram (figure 1A). He underwent pericardiocentesis for over 1L of serosanguinous fluid. Pericardial fluid demonstrated eosinophilic predominance, but extensive testing for infections, malignancy and immunologic disorders was negative. He was adequately dialyzed without evidence of uremia. Recurrence of the effusion prompted pericardial drain placement with high output drainage over next several days. Because of the lack of an apparent cause for recurrent pericardial effusion, the possibility of cyclosporine-induced pericardial effusion was entertained. Cyclosporine was switched to tacrolimus. Pericardial fluid drainage volume decreased gradually facilitating drain catheter removal. Follow up echocardiogram showed near complete resolution of the pericardial effusion (figure 1B).
Discussion
Cyclosporine-induced pericardial effusion is a rare but significant complication. The exact mechanism is unclear but thought to involve idiosyncratic or hypersensitivity reaction. Our patient's experience underscores the necessity of considering immunosuppressant-induced pericardial complications, especially when other causes are meticulously excluded.