Fig. 1

The clinical course of the presented case. The serum creatinine level was 0.5 mg/dL before lung transplantation. After transplantation, it stabilized at around 0.8 mg/dL. Over 2 years after transplantation, it had gradually deteriorated to 1.6 mg/dL, and the trough level of tacrolimus was lowered. It continued to increase to 4.3 mg/dL, and she was referred to nephrologists. Although multidisciplinary nephrological treatment was launched, hemodialysis had to be initiated only a year after the first nephrological referral