title: Rescue therapy with sirolimus in a renal transplant recipient with tacrolimus-induced hepatotoxicity.
abstract: Calcineurin inhibitors at elevated serum concentrations frequently cause mild elevation of the liver chemistries. Although rare, severe hepatotoxicity is their serious complication. A 54-year-old man with end-stage renal disease due to chronic glomerulonephritis without biopsy received a renal allograft from the deceased donor. Eleven days after transplantation severe liver injury (AST up to 421 IU/L, ALT 1242  IU/L, and GGT 212 IU/L) with the serum bilirubin within the normal range was recorded. Tacrolimus trough level was 5.5 ng/mL. Liver ultrasound and color-Doppler of the portal system were normal. Liver failure completely resolved after withdrawal of the calcineurin inhibitor and switch to sirolimus. After 9 months of follow-up our patient has excellent graft and liver function. Awareness of the possible association of tacrolimus use with hepatotoxicity is important to timely discontinuation of the causative agent, and to introduce sirolimus as the rescue therapy.
authors.affiliation: Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb and School of Medicine, University of Zagreb , Zagreb , Croatia.
authors.forename: Ines
authors.initials: I
authors.lastname: Mesar
authors.forename: Petar
authors.initials: P
authors.lastname: Kes
authors.forename: Tvrtko
authors.initials: T
authors.lastname: Hudolin
authors.forename: Nikolina
authors.initials: N
authors.lastname: Basic-Jukic
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000627:therapeutic use; D016559:Tacrolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus