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Case report
Role of tacrolimus in return of hand function after brachial plexus injury in a lung transplantation patient
  1. Tiam M Saffari1,2,
  2. Christopher J Arendt3,
  3. Robert J Spinner1,4 and
  4. Alexander Y Shin1,4
  1. 1Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Plastic-, Reconstructive- and Hand Surgery, Radboud University, Nijmegen, the Netherlands
  3. 3Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, United States
  4. 4Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
  1. Correspondence to Dr Alexander Y Shin; Shin.Alexander{at}


We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a brachial plexus injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. 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. While the neurotoxic effects of tacrolimus are more emphasised, the neuroregenerative properties have been recently explored. The recovery in this patient is unique and unusual after BPI and is most likely as a result of the low dose tacrolimus treatment.

  • musculoskeletal and joint disorders
  • drug interactions
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  • Contributors TMS: collected data and wrote manuscript. CJA: provided pharmacological input and critically reviewed manuscript. RJS: cared for study patient and critically reviewed manuscript. AYS: provided idea, collected data, cared for study patient and critically reviewed manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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