Tacrolimus-Associated Hemolytic Uremic Syndrome in a Pediatric Liver Transplant Recipient

The document described a case of tacrolimus-associated hemolytic uremic syndrome (HUS) in an 8-year-old male pediatric liver transplant recipient. Following the initiation of tacrolimus, the patient developed symptoms indicative of HUS, including hemolytic anemia, thrombocytopenia, and acute kidney injury. Tacrolimus was discontinued, and the patient was treated with intravenous methylprednisolone and switched to cyclosporine, which resolved the hemolysis and kidney injury. However, due to side effects from cyclosporine, the patient was later transitioned to sirolimus and eventually reintroduced to tacrolimus without recurrence of HUS. The case highlighted the rarity of tacrolimus-induced HUS in pediatric liver transplant patients and the importance of discontinuing tacrolimus to preserve renal function.