Ileana Constantinescu and Ion Mărunțelu
In multiple solid organ transplantation, one of the main concerns is the complex immunological and clinical management of transplanted recipients with the result of the graft rejection prevention. Selecting the personalized immunosuppressive regimens in such cases is also challenging. A too low dose of immunosuppressive drug may lead to de novo anti-HLA antibodies appearance with progressive graft loss, while too high doses may lead to drug toxicity primarily affecting the organs involved and the metabolism. Calcineurin inhibitors treatment failure makes the patient to return on the waiting list. We present the case of a liver transplanted female patient in whom the nephrotoxicity induced by post transplantation tacrolimus led to the need for kidney transplantation in order to save her life.