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KMID : 0882420120830030369
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Korean Journal of Medicine
2012 Volume.83 No. 3 p.369 ~ p.372
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A Case Report of Kidney Graft Failure after Duodenal Bypass Surgery
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Kim Ha-Neul
Cho Yul-Hee
Kim Young-Sin
Chun Hyun-Ji
Choi Su-Jin
Kim Eun-Oh
Yang Chul-Woo
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Abstract
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The calcineurin inhibitor-immunosuppressant tacrolimus is widely used in patients undergoing kidney transplantation. Although tacrolimus is absorbed from the entire gastrointestinal tract, the duodenum is the primary site of its absorption and metabolism. Therefore, duodenal bypass surgery in a renal transplant recipient can significantly disrupt tacrolimus absorption and metabolism. Here, we report a case of allograft failure that developed after duodenal bypass surgery. The patient was a 41-year-old woman who received a deceased donor kidney transplantation. She underwent a gastrojejunostomy due to a duodenal perforation and pancreatitis after endoscopic retrograde cholangiopancreatography. After the surgery, her blood tacrolimus level decreased gradually, and remained lower than therapeutic target levels, even after the tacrolimus dose was increased from 5 to 12 mg/day. Repetitive rejection developed and the patient suffered allograft failure 3 months after bypass surgery. This case raises the importance of drug absorption in renal transplant recipients undergoing duodenal bypass surgery.
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KEYWORD
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Tacrolimus, Immunosuppressant, Duodenal bypass, Renal transplantation, Acute rejection
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