Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2024

Open Access 01-12-2024 | Toxic Hepatitis | Case report

Tacrolimus-induced cholestatic hepatotoxicity after renal transplantation: a case report

Authors: Fatemeh Pourrezagholi, Hossein Amini, Omid Moradi, Shadi Ziaie

Published in: Journal of Medical Case Reports | Issue 1/2024

Login to get access

Abstract

Background

In this manuscript, we report a case of tacrolimus-associated hepatotoxicity in a kidney transplant recipient.

Case presentation

In this case report, a 56 years old Arab male patient who received a kidney transplant presented with icterus, weakness, and lethargy two weeks after transplantation and tacrolimus initiation. In laboratory analysis hyperbilirubinemia and a rise in hepatic enzymes were observed. All possible causes of hepatotoxicity were examined. The panel for infectious causes was negative. Drug-induced liver injury was diagnosed. The patient’s immunosuppressive regimen was changed to a cyclosporine-based regimen and after this change bilirubin and hepatic enzymes decreased and the patient was discharged without signs and symptoms of hepatitis.

Conclusion

It seems that the patient’s hyperbilirubinemia was due to tacrolimus, and the patient’s bilirubin decreased after stopping tacrolimus.
Literature
1.
go back to reference Sanchez-Campos S, Lopez-Acebo R, Gonzalez P, Culebras JM, Tuñon MJ, Gonzalez-Gallego J. Cholestasis and alterations of glutathione metabolism induced by tacrolimus (FK506) in the rat. Transplantation. 1998;66(1):84–8.CrossRefPubMed Sanchez-Campos S, Lopez-Acebo R, Gonzalez P, Culebras JM, Tuñon MJ, Gonzalez-Gallego J. Cholestasis and alterations of glutathione metabolism induced by tacrolimus (FK506) in the rat. Transplantation. 1998;66(1):84–8.CrossRefPubMed
2.
go back to reference Taniai N, Akimaru K, Ishikawa Y, Kanada T, Kakinuma D, Mizuguchi Y, Mamada Y, Yoshida H, Tajiri T. Hepatotoxicity caused by both tacrolimus and cyclosporine after living donor liver transplantation. J Nippon Med Sch. 2008;75(3):187–91.CrossRefPubMed Taniai N, Akimaru K, Ishikawa Y, Kanada T, Kakinuma D, Mizuguchi Y, Mamada Y, Yoshida H, Tajiri T. Hepatotoxicity caused by both tacrolimus and cyclosporine after living donor liver transplantation. J Nippon Med Sch. 2008;75(3):187–91.CrossRefPubMed
3.
go back to reference Hoofnagle JH, Björnsson ES. Drug-induced liver injury—types and phenotypes. N Engl J Med. 2019;381(3):264–73.CrossRefPubMed Hoofnagle JH, Björnsson ES. Drug-induced liver injury—types and phenotypes. N Engl J Med. 2019;381(3):264–73.CrossRefPubMed
4.
go back to reference Ferjani H, El Arem A, Bouraoui A, Achour A, Abid S, Bacha H, Boussema-Ayed I. Protective effect of mycophenolate mofetil against nephrotoxicity and hepatotoxicity induced by tacrolimus in Wistar rats. J Physiol Biochem. 2016;72(2):133–44.CrossRefPubMed Ferjani H, El Arem A, Bouraoui A, Achour A, Abid S, Bacha H, Boussema-Ayed I. Protective effect of mycophenolate mofetil against nephrotoxicity and hepatotoxicity induced by tacrolimus in Wistar rats. J Physiol Biochem. 2016;72(2):133–44.CrossRefPubMed
5.
go back to reference Vallet-Pichard A, Rerolle JP, Fontaine H, Larousserie F, Peraldi MN, Kreis H, Pol S. Veno-occlusive disease of the liver in renal transplant patients. Nephrol Dial Transplant. 2003;18(8):1663–6.CrossRefPubMed Vallet-Pichard A, Rerolle JP, Fontaine H, Larousserie F, Peraldi MN, Kreis H, Pol S. Veno-occlusive disease of the liver in renal transplant patients. Nephrol Dial Transplant. 2003;18(8):1663–6.CrossRefPubMed
6.
go back to reference Lv B, Liu L, Liu X, Huang M, Chen X, Tang K, Wang C, Chen P. Incidence, clinical features and risk factors of tacrolimus induced idiosyncratic liver injury in renal transplant recipients: a nested case-control study. Front Pharmacol. 2023;14:1126765.CrossRefPubMedPubMedCentral Lv B, Liu L, Liu X, Huang M, Chen X, Tang K, Wang C, Chen P. Incidence, clinical features and risk factors of tacrolimus induced idiosyncratic liver injury in renal transplant recipients: a nested case-control study. Front Pharmacol. 2023;14:1126765.CrossRefPubMedPubMedCentral
7.
go back to reference Yadav DK, Gera DN, Gumber MR, Kute VB, Patel MP, Vanikar AV, Trivedi HL. Tacrolimus-induced severe cholestasis complicating renal transplantation. Ren Fail. 2013;35(5):735–7.CrossRefPubMed Yadav DK, Gera DN, Gumber MR, Kute VB, Patel MP, Vanikar AV, Trivedi HL. Tacrolimus-induced severe cholestasis complicating renal transplantation. Ren Fail. 2013;35(5):735–7.CrossRefPubMed
8.
go back to reference Ganschow R, Albani J, Grabhorn E, Richter A, Burdelski M. Tacrolimus-induced cholestatic syndrome following pediatric liver transplantation and steroid-resistant graft rejection. Pediatr Transplant. 2006;10(2):220–4.CrossRefPubMed Ganschow R, Albani J, Grabhorn E, Richter A, Burdelski M. Tacrolimus-induced cholestatic syndrome following pediatric liver transplantation and steroid-resistant graft rejection. Pediatr Transplant. 2006;10(2):220–4.CrossRefPubMed
Metadata
Title
Tacrolimus-induced cholestatic hepatotoxicity after renal transplantation: a case report
Authors
Fatemeh Pourrezagholi
Hossein Amini
Omid Moradi
Shadi Ziaie
Publication date
01-12-2024

Other articles of this Issue 1/2024

Journal of Medical Case Reports 1/2024 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.