ArticleWorld journal of nephrology2025
Tacrolimus toxicity in kidney transplant recipient after wedge liver resection: A case report and review of literature.
Article in World journal of nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTacrolimus is a key immunosuppressive agent used to prevent allograft rejection in kidney transplant recipients. Due to its narrow therapeutic index, careful monitoring is essential to avoid adverse effects, particularly neurotoxicity and nephrotoxicity. Hepatic metabolism is an important part of tacrolimus pharmacokinetics. This case report highlights the impact of liver resection on tacrolimus pharmacokinetics in a kidney transplant recipient. CASE SUMMARY: A 61-year-old male with end-stage kidney disease underwent a living-unrelated donor kidney transplant at age 46 and has maintained a stable tacrolimus regimen for 15 years. He was later diagnosed with hepatocellular carcinoma and underwent an open wedge liver resection. Despite stable preoperative tacrolimus levels, he developed acute kidney injury and neurotoxicity (manifested as new-onset tremors and headache) postoperatively. Tacrolimus levels rose from 3.4 ng/mL before surgery to 19.5 ng/mL postoperatively, despite no changes in dosage. This increase was most likely due to reduced liver mass and function following resection, in addition to ischemic injury of the remaining liver parenchyma, leading to impaired drug metabolism and acute toxicity. Liver function tests showed transient abnormalities postoperatively, with transaminase levels peaking at 30 times the normal range before gradually returning to normal, coinciding with the decline in tacrolimus levels. The patient's symptoms and acute kidney injury improved as tacrolimus concentration returned to normal.
conclusionThis is the first reported case of acute tacrolimus neurotoxicity and nephrotoxicity in a kidney transplant recipient following liver resection. It highlights the critical need for vigilant therapeutic drug monitoring of tacrolimus after liver surgery to prevent severe adverse effects.
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