Rescue therapy with sirolimus in a renal transplant recipient with tacrolimus-induced hepatotoxicity. (12th September 2013)

• Record Type: Journal Article
• Authors: Mesar, Ines; Kes, Petar; Hudolin, Tvrtko; Basic-Jukic, Nikolina
• Is Part Of: Renal failure. Volume 35:Number 10(2013)
• Page Start: 1434
• Page End: 1435
• Publication Date: 2013-09-12
• Subjects: Hepatotoxicity -- renal transplantation -- sirolimus -- tacrolimus; Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.3109/0886022X.2013.828356
• Languages: English
• ISSNs: 0886-022X

Abstract

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.