Tacrolimus Toxicity due to Biliary Obstruction in a Combined Kidney and Liver Transplant Recipient

The immunosuppressant tacrolimus has a narrow therapeutic window, necessitating therapeutic drug monitoring to maintain efficacy and minimise toxicity. There are very few reports examining the impact of impaired biliary excretion on tacrolimus blood levels or toxicity. We report the case of a 26-yea...

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Bibliographic Details
Published inCase reports in transplantation Vol. 2017; no. 2017; pp. 1 - 4
Main Authors Francis, Ross S., Johnson, David W., Burke, Michael T., Chan, Samuel, Mudge, David W.
Format Journal Article
LanguageEnglish
Published Cairo, Egypt Hindawi Publishing Corporation 01.01.2017
Hindawi
John Wiley & Sons, Inc
Hindawi Limited
Subjects
Bile
Bioavailability
Care and treatment
Case Report
Cholecystectomy
Cholestasis
Cytochrome
Delirium
Diagnosis
Dosage and administration
Drug dosages
Enzymes
Family medical history
Health aspects
Hypertension
Jaundice, Obstructive
Kidneys
Liver
Metabolism
Metabolites
Organ transplant recipients
Phosphatase
Tacrolimus
Toxicity
Transplantation
Transplants & implants
Urine
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Summary:The immunosuppressant tacrolimus has a narrow therapeutic window, necessitating therapeutic drug monitoring to maintain efficacy and minimise toxicity. There are very few reports examining the impact of impaired biliary excretion on tacrolimus blood levels or toxicity. We report the case of a 26-year-old combined liver and kidney transplant recipient, who developed acute biliary obstruction leading to tacrolimus toxicity with very high blood tacrolimus levels. Despite a careful evaluation, no alternative cause was found for her acute kidney injury, and her kidney function returned to previous baseline within several days following treatment of the biliary obstruction and temporary withdrawal of tacrolimus.
Bibliography:Academic Editor: David Conti
ISSN:2090-6943
2090-6951
DOI:10.1155/2017/9096435