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Case Reports
. 2017:2017:9096435.
doi: 10.1155/2017/9096435. Epub 2017 Jan 9.

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

Samuel Chan  1 , Michael T Burke  1 , David W Johnson  1 , Ross S Francis  1 , David W Mudge  1
Affiliations
Case Reports

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

Samuel Chan et al. Case Rep Transplant. 2017.

Abstract

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.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Cholangiogram demonstrating filling defects representative of biliary stones (arrows) present in the common bile duct.
Figure 2
Figure 2
Serum bilirubin, creatinine, and tacrolimus concentrations and total daily tacrolimus dosage throughout patient admission.
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