From bench to bed: deep insights the tacrolimus-induced diabetes and gut microbiota dysbiosis

The gut-liver axis is particularly vulnerable, and the alterations in gut microbiota composition have been linked to post-transplant complications. Liver transplantation is a life-saving procedure for patients with end-stage liver disease, but post-transplant complications are common and can significantly impact long-term outcomes. Tacrolimus is a widely used immunosuppressive agent in liver transplantation, primarily aimed at preventing graft rejection and promoting long-term graft survival. However, its effects on gut microbiota and the subsequent metabolic consequences remain underexplored. In this review, we will synthesize the latest findings on the effects of tacrolimus on gut microbiota in liver transplant patients and discuss how these changes may contribute to the development of diabetes and insulin resistance. By elucidating the interplay between tacrolimus, gut microbiota, and metabolic health, we aim to provide insights into potential therapeutic strategies for improving post-transplant outcomes.