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Tacrolimus Toxicity Diarrhoea Cycle — ESENeph MCQ

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HardTransplantationTacrolimus Toxicity Diarrhoea CycleESENeph

A 50-year-old kidney transplant recipient on Tacrolimus, MMF, and Prednisolone develops diarrhoea, abdominal pain, and rising creatinine. Tacrolimus trough is 12 ng/mL (target 5-8). Stool tests for infection are negative. What is the most likely cause?

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Correct answer: B — Tacrolimus-induced diarrhoea with secondary toxicity from dehydration

While MMF commonly causes diarrhoea, in this case the elevated Tacrolimus trough (12 vs target 5-8 ng/mL) is key. Diarrhoea from any cause (including MMF toxicity) can increase Tacrolimus absorption and reduce its metabolism, leading to supratherapeutic levels. The elevated Tacrolimus itself causes further diarrhoea and nephrotoxicity. This creates a vicious cycle. Management includes reducing Tacrolimus dose, managing the diarrhoea, and investigating whether MMF dose reduction is needed.

Reference: https://guidelines.ukkidney.org