The triggering factors for EDKA in this case included type 1 diabetes, reduced carbohydrate intake, SGLT2i use, and insulin pump therapy [9]. Although insulin pump therapy was combined with an SGLT2i to improve glycemic control, this combination may have further increased the risk of ketoacidosis. Moreover, the inappropriate discontinuation of exogenous insulin during the transplant procedure likely led to relative insulin deficiency and worsening acidosis. Here, INS is linked to type 1 diabetes mellitus.