title: Unusual case of tacrolimus vascular toxicity after deceased donor renal transplantation.
abstract: We report a case of tacrolimus vascular toxicity found on a protocol biopsy shortly after a deceased donor renal transplantation. The patient was immunologically high-risk and acute antibody-mediated rejection during post-transplant dialysis phase was suspected on the protocol biopsy. Although the patient was stable after treatment of rejection, a further examination showed a very rare but specific side-effect of tacrolimus. It is sometimes difficult to make a differential diagnosis during postoperative dialysis period among AMR, primary non-functioning, drug toxicity, infection or just prolonged recovery from the damage of a long agonal phase on the non-heart beating donor. Although the possibilities of coexistence of rejection or other causes such as infection have not been completely excluded, it is important to be aware of this unusual side effect of tacrolimus.
authors.affiliation: Departments of Surgery, Yonago-city, Tottori, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sugitani
authors.affiliation: Departments of Urology, Yonago-city, Tottori, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Takahashi
authors.affiliation: Departments of Surgery, Yonago-city, Tottori, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Naka
authors.affiliation: Departments of Surgery, Yonago-city, Tottori, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Hisamitsu
authors.affiliation: Departments of Surgery, Yonago-city, Tottori, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamamoto
authors.affiliation: Departments of Surgery, Yonago-city, Tottori, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Taniguchi
authors.affiliation: Departments of Urology, Yonago-city, Tottori, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Departments of Internal Medicine, Yonago-city, Tottori, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Departments of Pathology, Yonago Medical Center, Yonago-city, Tottori, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Departments of Surgery, Yonago-city, Tottori, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hamazoe
mesh_terms: D064591:Allografts; D001160:Arterioles / Q000187:drug effects* / Q000473:pathology; D001706:Biopsy; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006084:Graft Rejection / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011237:Predictive Value of Tests; D016559:Tacrolimus / Q000009:adverse effects*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000139:chemically induced* / Q000473:pathology; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: acute antibody-mediated rejection; non-heart beating donor; protocol biopsy; renal transplantation; tacrolimus toxicity