Tacrolimus-induced Ascites after Liver Transplant

Area of Science:

• Hepatology
• Transplantation Medicine
• Clinical Pharmacology

Background:

• Massive post-transplantation ascites is a rare complication following liver transplantation.
• Etiologies can be multifactorial, and sometimes remain unidentified.
• Drug-induced complications are a potential, though less common, cause.

Observation:

• A 49-year-old male with hepatitis B virus cirrhosis developed progressive massive ascites 10 days post-liver transplantation.
• The patient was on a standard immunosuppressive regimen including tacrolimus, mycophenolate, and prednisolone.
• Despite normal liver function tests and negative investigations including liver biopsy, the etiology remained unknown.

Findings:

• Discontinuation of tacrolimus and switching to rapamycin resulted in complete resolution of ascites.
• The patient remained asymptomatic for over two years post-intervention.
• This case highlights tacrolimus as a potential, albeit rare, cause of post-transplantation ascites.

Implications:

• Tacrolimus should be considered in the differential diagnosis of unexplained massive ascites post-liver transplantation.
• Discontinuation or switching of tacrolimus may be an effective treatment strategy.
• Further research into drug-induced ascites in transplant recipients is warranted.