The drug causes a dose-dependent reduction in leukocyte and platelet counts. Development of severe renal dysfunction warrants closer monitoring with possible reduction in dosage. The major toxic effects are neutropenia and thrombocytopenia. Corticosteroids Essentially all patients receive corticosteroids following transplantation. The latter may lead to volume overload and hypertension.
Acute rejection is cell mediated and results in myocardial dysfunction in more severe cases.
Chronic rejection involves progressive coronary artery stenosis over the course of years and terminates in myocardial ischemia with its attendant consequences. Nephrotoxicity may result from cyclosporine A use and may occur at usual therapeutic levels. Hyperkalemia may result, as may hypervolemia and hypertension. Presenting symptoms Heart transplant recipients may present to the ED for any complaint observed in the general population. Vigilance must be maintained to detect rejection and infection, because these conditions may have subtle presentations.