Sudden Hearing Loss in a Cyclosporin-Treated Renal Transplantation Patient

Turgay Arinsoy, Nephrology and Otolaryngology Departments, Hacettepe University Medical School, T-06100 Ankara (Turkey) Sir, Thromboembolic complications constitute an important risk in the postoperative course after renal transplantation. The incidence has been reported to be as high as 24% [1]. We present a case of sudden hearing loss due to a thromboembolic event in a renal transplant recipient on triple immunosup-pressive treatment consisting of cyclosporin A (CsA), azathioprine (Aza) and predniso-lone (Pred). A 22-year-old Caucasian male with end-stage renal disease secondary to membrano-proliferative glomerulonephritis underwent a living-related donor renal transplantation. The patient had been maintained on a hemo-dialysis program for 3 months prior to renal transplantation. Initial laboratory results showed that serum creatinine level and blood urea nitrogen were 397 μmol/l and 18.3 mmol/l, respectively. The remainder of his laboratory results including prothrombin time (FT), partial thromboplastin time (PTT), chest X-ray and electrocardiogram were within normal limits. Before the operation, CsA was given in a single dose of 4 mg/kg orally. Methylpredni-solone 1,000 mg and Aza 150 mg were given intravenously during surgery. On the operation day, Pred 100 mg was given orally and tapered by 10 mg daily until the dose of 20 mg per day. He received CsA (4 mg/kg) b.i.d. and Aza (1.5 mg/kg/day) in a single oral dose. He tolerated the operation well and had good urine output postoperatively. On the 7th postoperative day, the patient complained of right sudden hearing loss. On the same day, his blood CsA level was measured as 200 ng/ml, and serum creatinine level was 106 μmol/l. PT and PTT were within normal limits. Because of right sudden hearing loss, the patient was referred to the Otolaryngology Department. He had not any vestibular symptoms, otolaryngologic examination revealed no abnormality except for tuning fork tests. With the tuning fork at 512 cps, there was no response on the right ear. The patient localized the sound in the left ear on the Weber test. Investigations included a full range of