Oncol Case Rep J | Volume 8, Issue 1 | Case Series | Open Access

Fludrocortisone for the Treatment of Tacrolimus-Induced Hyperkalemia in Adult Stem Cell Transplant Patients: A Case Series and Literature Review

Emma Anisman, Sarah Houtmann, Margaret Kasner and Gina Keiffer^*

Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Thomas Jefferson University, USA

^*Correspondance to: Gina Keiffer 

Abstract

Tacrolimus is an essential immunosuppressant for hematopoietic stem cell transplant recipients but is frequently associated with hyperkalemia. While fludrocortisone is a known therapy for calcineurin inhibitor–induced hyperkalemia in solid organ transplant, its efficacy in adult stem cell transplant recipients has not been characterized. We present a retrospective case series of five adult allogeneic stem cell transplant patients who developed hyperkalemia while on tacrolimus. Each patient was treated with fludrocortisone (0.1 mg daily), with or without concurrent intravenous fluids or loop diuretics, based on clinical status. All patients experienced an improvement in serum potassium concentration, with an average time to normalization of 5.4 days. Notably, three patients who were refractory to furosemide achieved resolution of hyperkalemia after starting fludrocortisone. None of the five patients experienced adverse effects attributable to fludrocortisone, and tacrolimus therapy was successfully continued throughout their post-transplant course. These findings are consistent with prior reports in pediatric and adult solid organ transplant populations, which have demonstrated the safety and efficacy of fludrocortisone for managing calcineurin inhibitor–induced hyperkalemia. To our knowledge, this is the first report of fludrocortisone use for tacrolimus-induced hyperkalemia in adult stem cell transplant recipients. While our sample size is limited, our results support fludrocortisone as a well-tolerated and effective strategy for the rapid management of tacrolimusinduced hyperkalemia. Further studies are warranted to define optimal dosing, duration, and longterm outcomes.

Keywords:

#

Citation:

Anisman E, Houtmann S, Kasner M, Keiffer G. Fludrocortisone for the Treatment of Tacrolimus-Induced Hyperkalemia in Adult Stem Cell Transplant Patients: A Case Series and Literature Review. Oncol Case Report J. 2025; 8(1): 1067..