Abstract
This 16-year-old girl with methylmalonic acidemia complicated by chronic kidney disease underwent hepatorenal transplantation with an uneventful postoperative course. She was discharged on prednisone, mycophenolate mofetil, tacrolimus, trimethoprim-sulfamethoxazole, and valganciclovir. Her peak trough of tacrolimus during initiation was 17.1 ng/mL (goal: 10 to 15 ng/mL). At 1.5 weeks after transplant she developed intermittent “jerking” about her abdominal incision. Soon after, she slumped, developed rightward head version with right face/eyelid twitching, and became unresponsive with generalized tremulousness for two minutes.
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