Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb and School of Medicine, University of Zagreb , Zagreb , Croatia.
Ren Fail. 2013;35(10):1434-5. doi: 10.3109/0886022X.2013.828356. Epub 2013 Sep 13.
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.
钙调磷酸酶抑制剂在血清浓度升高时经常引起肝化学物质的轻度升高。虽然罕见，但严重的肝毒性是其严重的并发症。一名 54 岁男性，因慢性肾小球肾炎未经活检导致终末期肾病，接受了已故供体的肾移植。移植后 11 天，记录到严重的肝损伤（AST 高达 421IU/L，ALT 1242IU/L，和 GGT 212IU/L），血清胆红素在正常范围内。他的他克莫司谷浓度为 5.5ng/mL。肝脏超声和门静脉彩色多普勒均正常。停用钙调磷酸酶抑制剂并改用西罗莫司后，肝功能衰竭完全缓解。了解他克莫司使用与肝毒性之间可能存在的关联对于及时停用致病药物以及引入西罗莫司作为挽救性治疗非常重要。
