Objective  To explore the clinical features of tacrolimus-related acute pancreatitis(AP).

Methods  The databases of CNKI, Wanfang Data, VIP, PubMed and Web of Science were searched (up to March 10, 2023), and the case reports of tacrolimus-related AP were collected and descriptively analyzed.

Results  A total of 19 cases were collected from 17 documents, including 10 males and 9 females, ages ranged from 3 to 65 years. A total of 21 case-times of tacrolimus related AP occurred. The plasma concentration of tacrolimus was more than 15 ng·mL^-1 in 11 case-times of AP, of which 8 case-times were close to or more than 30 ng·mL^-1. The time from the first application of tacrolimus to the occurrence of AP in 19 patients was 3 days to 7 years, the median time was 20 days, and the second occurrence of AP in 2 patients was 37 days and 75 days, respectively. The clinical symptoms, laboratory tests, and imaging findings of tacrolimus-related AP were similar to those caused by other drugs. The main symptom was abdominal pain, some patients were accompanied by nausea, vomiting and diarrhea, a small number of patients with diabetes or diabetes ketosis symptoms, and severe patients with shock symptoms. After the diagnosis of AP, treatment measures were described in 20 cases, 15 patients discontinued or reduced the dose of tacrolimus. 15 case-times were relieved or improved, 5 cases died, including 2 cases of AP-related death.

Conclusions  Tacrolimus may cause AP, with a generally good prognosis, and in severe cases, death may occur. Early identification and timely treatment are essential, especially for patients treated with multiple drugs. The blood concentration of tacrolimus should be closely monitored.

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