# Tacrolimus-Induced Gallstone Formation in the Early Post-renal Transplant Period: A Case Report

## TL;DR

This case report describes a patient who developed gallstones after a kidney transplant, possibly linked to tacrolimus use, a drug commonly used to prevent organ rejection.

## Contribution

The report highlights a rare but important association between tacrolimus and gallstone formation in renal transplant recipients.

## Key findings

- A 33-year-old female developed gallstones six weeks after kidney transplant while on tacrolimus.
- The patient had no traditional risk factors for gallstones, suggesting tacrolimus may be a contributing factor.
- Pre-transplant imaging showed no biliary issues, indicating the gallstones formed post-transplant.

## Abstract

Gallstone disease (GSD) is a known but relatively underrecognized complication in renal transplant (RT) recipients, particularly in those receiving cyclosporine. However, there is scarce data on the association between tacrolimus use and cholelithiasis. We present the case of a 33-year-old female with end-stage renal disease who underwent an ABO-compatible RT and was initiated on a standard triple immunosuppressive regimen consisting of tacrolimus (3.5 mg/day), mycophenolate mofetil (1.5 g/day), and prednisolone (20 mg/day). Six weeks post-transplant, she developed acute abdominal pain, nausea, and right upper quadrant tenderness with a positive Murphy’s sign. Abdominal ultrasonography revealed multiple gallstones, the largest measuring 8 mm. She was managed conservatively and notably lacked traditional risk factors for gallstone formation. Pre-transplant imaging had not revealed any biliary abnormalities. Tacrolimus as a cause of GSD remains underreported. This report highlights the need for increased clinical awareness and further research to understand its potential role in post-transplant biliary complications.