The Impact of Tacrolimus in Lower Extremity Surgical Wounds

Introduction: Tacrolimus is an immunosuppressant used in solid organ transplantation. Tacrolimus, a calcineurin inhibitor, affects T-cell activation, and it is conceivable that Tacrolimus would inhibit wound healing since inflammatory T- cells are involved in the healing process. The effect of tacrolimus on wound healing was not known until it was studied in 1998 and was revealed that tacrolimus decreased nitric oxide synthesis which led to impaired wound healing.

Purpose: The effects of tacrolimus in lower extremity surgical wounds has not been documented to the best of our knowledge. We present two cases of organ transplant recipients on tacrolimus who developed foot ulcers and discuss their wound care management.

Results: Case study 1 patient did not suffer from impaired healing of her surgical incision while taking a total of 4 mg of Tacrolimus daily and Prednisone 7.5 mg daily. Case study 2 did develop wounds but they eventually healed after appropriate wound care, debridements, grafting and extensive revascularization.

Discussion: The standard regimen of immunosuppressive therapy in solid organ transplantation includes a high dose (>5 mg) and long term duration (>1 month) of a corticosteroid. Corticosteroids have been implicated in dehiscence of surgical incisions, increased risk of wound infection, and delayed wound healing.

Conclusion: Therefore, it seems it would be impossible to ascertain in clinical trials (involving actual organ recipients) that Tacrolimus as a single drug disrupts wound healing.