Tacrolimus‐induced acute pancreatitis and diabetic ketoacidosis (DKA) in pediatric kidney transplant recipient. (1st December 2021)

• Record Type: Journal Article
• Authors: Mazumder, Mastakim Ahmed; Gulati, Sanjeev; Narula, Ajit Singh; Shehwar, Durre; Mir, Ishrat Majid
• Is Part Of: Pediatric transplantation. Volume 26:Number 2(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-12-01
• Subjects: diabetic ketoacidosis -- drug‐induced pancreatitis -- hypertriglyceridemia -- kidney transplant -- tacrolimus; Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.14194
• Languages: English
• ISSNs: 1397-3142

Abstract

Abstract: Background: Calcineurin inhibitors (CNIs) are often associated with abnormalities in glucose and lipid metabolism. Tacrolimus is the most potent CNI which is nowadays used almost universally as a part of triple‐drug immunosuppression after kidney transplantation. Tacrolimus can cause islet cell damage and decrease in insulin secretion which can lead to post‐transplant diabetes mellitus and rarely diabetic ketoacidosis. Although rare, acute pancreatitis has also been implicated by a few case reports to be associated with tacrolimus. However, tacrolimus‐induced acute pancreatitis has not been reported in pediatric kidney transplant recipient till date. Case Description: We report the first case of tacrolimus‐induced acute pancreatitis in association with hypertriglyceridemia and DKA in a child early after kidney transplant. The patient was managed with supportive treatment, and tacrolimus was stopped for three days and then switched to cyclosporine‐based regimen. The patient became euglycemic within 8 weeks of switching to cyclosporine and did not have any recurrence of pancreatitis. Conclusion: Tacrolimus‐induced pancreatitis is rare in the setting of kidney transplants and prompt diagnosis and management can lead to a successful outcome.