{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T17:00:41Z","timestamp":1757610041333,"version":"3.44.0"},"reference-count":13,"publisher":"SMC Media","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Tacrolimus is a commonly used immunosuppressant with well-defined side effects, including hypertriglyceridemia and hyperglycaemia. However, acute pancreatitis is still not widely recognized as an adverse event related to tacrolimus. Case presentation:\u00a0A 60-year-old male was admitted to the intensive care unit with symptoms and signs of acute pancreatitis. He underwent lung transplantation 4 years ago and since then received tacrolimus, mycophenolate mofetil (MMF) and prednisone. His initial laboratory tests revealed elevated serum amylase and lipase, high inflammatory parameters, markedly elevated triglycerides and hyperglycemia with diabetic ketoacidosis. He was treated with continuous insulin infusion, electrolyte correction, crystalloid titration and antimicrobial therapy. During the fasting period, immunosuppression was maintained with parenteral methylprednisolone and tacrolimus. Gradually, oral tacrolimus, MMF and full enteral nutrition were introduced. A control computed tomography scan showed pancreatic body necrosis with a large pseudocyst. The patient was discharged on a strict diet, fenofibrate and short- and long-acting insulin. Immunosuppressive therapy with tacrolimus, MMF and prednisone was continued. He was hospitalized several times within a year due to complications of severe necrotizing pancreatitis. Conclusion:\u00a0Acute pancreatitis associated with the use of tacrolimus is rare. Factors contributing to its occurrence are longer exposure period, toxic levels of the drug and concurrent metabolic derangements, predominantly hypertriglyceridemia. In this case report we present a patient after lung transplantation on tacrolimus therapy who developed severe acute necrotizing pancreatitis along with hypertriglyceridemia and diabetes mellitus. We also conducted a literature search and found 13 other cases of acute pancreatitis presumably related to tacrolimus therapy.<\/jats:p>","DOI":"10.12890\/2025_005619","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T09:31:31Z","timestamp":1753263091000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute pancreatitis associated with tacrolimus in a lung transplant recipient: a case report and review of literature"],"prefix":"10.12890","volume":"12","author":[{"given":"Ana","family":"\u0160maguc","sequence":"first","affiliation":[{"name":"Department of Clinical Immunology, Rheumatology and Pulmonology, Clinical Hospital Sveti Duh, Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maja","family":"Ma\u010dkovi\u0107","sequence":"first","affiliation":[{"name":"Intensive care unit, Clinical Hospital Sveti Duh, Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5772-0306","authenticated-orcid":false,"given":"Nikolina","family":"Mari\u0107","sequence":"first","affiliation":[{"name":"Intensive care unit, Clinical Hospital Sveti Duh, Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikola","family":"Udiljak","sequence":"first","affiliation":[{"name":"Intensive care unit, Clinical Hospital Sveti Duh, Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"10.12890\/2025_005619_ref1","doi-asserted-by":"crossref","unstructured":"Sastry J, Young S, Shaw PJ. Acute pancreatitis due to tacrolimus in a case of allogeneic bone marrow transplantation. Bone Marrow Transplant 2004;33:867-868. doi: 10.1038\/sj.bmt.1704429","DOI":"10.1038\/sj.bmt.1704429"},{"key":"10.12890\/2025_005619_ref2","doi-asserted-by":"crossref","unstructured":"Uemoto S, Tanaka K, Honda K, Tokunaga Y, Sano K, Katoh H, Yamamoto E, Takada Y, Ozawa K. Experience with FK506 in living-related liver transplantation. Transplantation 1993;55:288-292. doi: 10.1097\/00007890-199302000-00011","DOI":"10.1097\/00007890-199302000-00011"},{"key":"10.12890\/2025_005619_ref3","doi-asserted-by":"crossref","unstructured":"Mazumder MA, Gulati S, Narula AS, Shehwar D, Mir IM. Tacrolimus-induced acute pancreatitis and diabetic ketoacidosis (DKA) in pediatric kidney transplant recipient. Pediatr Transplant 2022;26:e14194. doi: 10.1111\/petr.14194","DOI":"10.1111\/petr.14194"},{"key":"10.12890\/2025_005619_ref4","doi-asserted-by":"crossref","unstructured":"Ogunseinde BA, Wimmers E, Washington B, Iyob M, Cropper T, Callender CO. A case of tacrolimus (FK506)-induced pancreatitis and fatality 2 years postcadaveric renal transplant. Transplantation 2003;76:448. doi: 10.1097\/01.TP.0000070434.73865.7A","DOI":"10.1097\/01.TP.0000070434.73865.7A"},{"key":"10.12890\/2025_005619_ref5","doi-asserted-by":"crossref","unstructured":"Xu J, Xu L, Wei X, Li X, Cai M. A case report: acute pancreatitis associated with tacrolimus in kidney transplantation. BMC Nephrol 2019;20:209. doi: 10.1186\/s12882-019-1395-x","DOI":"10.1186\/s12882-019-1395-x"},{"key":"10.12890\/2025_005619_ref6","doi-asserted-by":"crossref","unstructured":"Liu XH, Chen H, Tan RY, Luo C. Acute pancreatitis due to tacrolimus in kidney transplant and review of the literature. J Clin Pharm Ther 2021;46:230-235. doi: 10.1111\/jcpt.13269","DOI":"10.1111\/jcpt.13269"},{"key":"10.12890\/2025_005619_ref7","doi-asserted-by":"crossref","unstructured":"Ding Y, Qu C, He H, Cao F, Ou T, Li F. Case Report: Acute Pancreatitis Associated With Tacrolimus in Kidney Transplantation and a Review of the Literature. Front Med (Lausanne) 2022;9:843870. doi: 10.3389\/fmed.2022.843870","DOI":"10.3389\/fmed.2022.843870"},{"key":"10.12890\/2025_005619_ref8","doi-asserted-by":"crossref","unstructured":"AlQahtani A, Alali MN, Allehiani S. Immunosuppressant-induced late acute pancreatitis after laparoscopic sleeve gastrectomy: a case report and literature review. J Surg Case Rep 2019;2019:rjz380. doi: 10.1093\/jscr\/rjz380","DOI":"10.1093\/jscr\/rjz380"},{"key":"10.12890\/2025_005619_ref9","doi-asserted-by":"crossref","unstructured":"Peng M, Lin T, Song Z, Huang T, Pan X. High-Dose Tacrolimus-Induced Acute Pancreatitis After Kidney Transplantation: A Case Report. Pancreas 2025;54:e73-e74. doi: 10.1097\/MPA.0000000000002382","DOI":"10.1097\/MPA.0000000000002382"},{"key":"10.12890\/2025_005619_ref10","doi-asserted-by":"crossref","unstructured":"Nieto Y, Russ P, Everson G, Bearman SI, Cagnoni PJ, Jones RB, Shpall EJ. Acute pancreatitis during immunosuppression with tacrolimus following an allogeneic umbilical cord blood transplantation. Bone Marrow Transplant 2000;26:109-11. doi: 10.1038\/sj.bmt.1702471","DOI":"10.1038\/sj.bmt.1702471"},{"key":"10.12890\/2025_005619_ref11","doi-asserted-by":"crossref","unstructured":"Tsutsumi Y, Kanamori H, Mashiko S, Yamato H, Ibata M, Ehira N, et al. Leukoencephalopathy with cerebral hemorrhage following acute pancreatitis due to tacrolimus in a case of allogeneic peripheral blood stem cell transplantation. Leuk Lymphoma. 2006 May;47(5):943\u20137.","DOI":"10.1080\/10428190500404449"},{"key":"10.12890\/2025_005619_ref12","doi-asserted-by":"crossref","unstructured":"Im MS, Ahn HS, Cho HJ, Kim KB, Lee HY. Diabetic ketoacidosis associated with acute pancreatitis in a heart transplant recipient treated with tacrolimus. Exp Clin Transplant 2013;11:72-74. doi: 10.6002\/ect.2012.0106","DOI":"10.6002\/ect.2012.0106"},{"key":"10.12890\/2025_005619_ref13","doi-asserted-by":"crossref","unstructured":"Khan BA, Deel C, Hellman RN. Tumor lysis syndrome associated with reduced immunosuppression in a lung transplant recipient. 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