A Liver Transplant Patient Experienced Deterioration of Renal Function and Rhabdomyolysis after Taking Sirolimus: A Case report

Abstract

Abstract The occurrence of renal impairment and rhabdomyolysis in transplant patients taking sirolimus was very rare. We report a case of a 54-year-old male who received liver transplantation and was initially treated with tacrolimus, mycophenolate mofetil and glucocorticoids for immunosuppression. After developing renal dysfunction, tacrolimus was replaced with sirolimus. However, one month after taking sirolimus, the patient's renal function continued to deteriorate, and rhabdomyolysis developed one and a half months later. Serum analysis indicated high sirolimus concentration, while renal histopathology revealed acute tubular injury and interstitial arteriopathy. After reducing the dosage of sirolimus, the patient's creatine kinase levels returned to normal and renal function improved compared to before. 2 years after hospital discharge, the patient's renal function further recovered. This case highlights the importance of monitoring sirolimus blood concentration in clinical practice, as elevated drug concentrations can lead to renal dysfunction and rhabdomyolysis as adverse reactions. Further investigation into the pathogenic mechanisms of sirolimus-induced renal dysfunction and rhabdomyolysis may contribute to clinical practice.