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ERIC GROUZMANN, PHARM.D., PH.D., is Group Leader; THIERRY BUCLIN, M.D., is Associate Medical Doctor; and JEROME BIOLLAZ, M.D., is Head, Division of Clinical Pharmacology and Toxicology, Lausanne University Medical School, Lausanne, Switzerland.

Address correspondence to Dr. Grouzmann at the Division of Clinical Pharmacology and Toxicology, Lausanne University Medical School, 1011, Lausanne, Switzerland (eric.grouzmann{at}chuv.ch).

Purpose. A misleading blood tacrolimus concentration (BTC) value caused by the contamination of a central venous catheter previously used for tacrolimus administration is described. Summary. A 59-year-old woman with severe chronic obstructive pulmonary disease successfully underwent double lung transplantation. In the intensive care unit, she received a continuous i.v. infusion of tacrolimus from days 1 to 5 after transplantation through the distal lumen of a polyurethane triple-lumen central venous catheter. The catheter lumen was flushed twice a day with 0.9% sodium chloride injection. The proximal lumen was used for blood sampling after being flushed; the first 10 mL of blood was discarded. BTCs determined in whole blood one, four, and five days after transplantation were within the therapeutic range of 5–15 ng/mL. On day five the patient was transferred to the thoracic surgery ward and was switched to oral tacrolimus 1.5 mg twice daily. The BTC on day 6 was unexpectedly high at 134.5 ng/mL. The patient’s clinical status was normal, and no signs of tacrolimus toxicity were observed. On day 7, blood samples were drawn from a peripheral vein and simultaneously through the central venous catheter. Although the central venous catheter had not been exposed to tacrolimus during the preceding two days, it yielded blood with a BTC eight times higher than the BTC in blood from the peripheral vein (41.4 ng/mL versus 5.1 ng/mL). Conclusion. The collection of blood from a central venous catheter lumen that had been used for tacrolimus administration resulted in a BTC about eight times higher than what was measured in peripheral blood. Index terms: Blood levels; Catheters; Contamination; Immunosuppressive agents; Lung diseases; Tacrolimus; Transplantation