scholarly journals Drug Interaction between Sirolimus and Ranolazine in a Kidney Transplant Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Joanna C. Masters ◽  
Mita M. Shah ◽  
Ashley A. Feist
Keyword(s):  
Drug Interaction ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Immunosuppressive Agent ◽  
Therapeutic Window ◽  
Blood Levels ◽  
Kidney Transplant Patient ◽  
Close Monitoring ◽  
Subsequent Increase

Purpose. The case of a kidney transplant recipient who experienced a probable drug interaction between sirolimus and ranolazine is reported.Summary. The narrow therapeutic window of immunosuppressive therapy in transplant recipients requires close monitoring for potential drug-drug interactions. The patient, a 57-year-old Caucasian male kidney transplant recipient, was stable for years on sirolimus as his primary immunosuppressive agent and had a history of chronic angina, for which he was prescribed ranolazine. Upon addition and dose escalation of ranolazine, whole blood sirolimus levels more than tripled, rising to immeasurably high concentrations. After holding sirolimus on multiple occasions and reducing dosage more than 50%, blood levels returned to therapeutic range, while continuing ranolazine.Conclusion. Since ranolazine is a documented P-GP and CYP3A inhibitor, and sirolimus a known substrate for both pathways, it is proposed that ranolazine inhibition of P-GP and CYP3A4 contributed to the significant elevation in sirolimus exposure. No alternative causes for the rise in sirolimus exposure were found, and assessment with the Drug Interaction Probability Scale finds this interaction to be probable. Clinicians should be aware of the potential for this interaction to cause elevated sirolimus exposure and subsequent increase in clinical effect or toxicity, in this case overimmunosuppression.

scholarly journals Sepsis-like histoplasmosis in a kidney transplant patient

2018 ◽  
Vol 40 (1) ◽  
pp. 95-97 ◽  
Author(s):  
Ana Raquel Fernandes ◽  
Laila Almeida Viana ◽  
Juliana Busato Mansur ◽  
Mariana de Moraes Françoso ◽  
Daniel Wagner de Castro Lima Santos ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Skin Biopsy ◽  
Kidney Transplant ◽  
Liposomal Amphotericin ◽  
Transplant Patient ◽  
Kidney Transplant Recipient ◽  
Kidney Transplant Patient ◽  
Fungus Infection ◽  
Immunosuppressed Patients ◽  
Severe Manifestation

Abstract Histoplasmosis is a fungus infection that mainly affects immunosuppressed patients. The authors present a case of a kidney transplant recipient who developed sepsis-like histoplasmosis, na atypical but severe manifestation of the disease. The fungus was found in blood and in a skin biopsy, and the treatment with liposomal amphotericin resulted in hepatotoxicity.

scholarly journals Tacrolimus Toxicity due to Biliary Obstruction in a Combined Kidney and Liver Transplant Recipient

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Samuel Chan ◽  
Michael T. Burke ◽  
David W. Johnson ◽  
Ross S. Francis ◽  
David W. Mudge
Keyword(s):  
Transplant Recipient ◽  
Biliary Obstruction ◽  
Kidney Transplant Recipient ◽  
Kidney Injury ◽  
Therapeutic Window ◽  
Therapeutic Drug ◽  
Blood Levels ◽  
Liver And Kidney ◽  
The Impact ◽  
Very High

The immunosuppressant tacrolimus has a narrow therapeutic window, necessitating therapeutic drug monitoring to maintain efficacy and minimise toxicity. There are very few reports examining the impact of impaired biliary excretion on tacrolimus blood levels or toxicity. We report the case of a 26-year-old combined liver and kidney transplant recipient, who developed acute biliary obstruction leading to tacrolimus toxicity with very high blood tacrolimus levels. Despite a careful evaluation, no alternative cause was found for her acute kidney injury, and her kidney function returned to previous baseline within several days following treatment of the biliary obstruction and temporary withdrawal of tacrolimus.

scholarly journals Secondary Hemophagocytic Lymphohistiocytosis Complicated by a Cavitary Lung Lesion in a Kidney Transplant Recipient

2021 ◽  
pp. 195-203
Author(s):  
Katarzyna Muras-Szwedziak ◽  
Maciej Tylski ◽  
Anna Masajtis-Zagajewska ◽  
Michał Nowicki
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Laboratory Tests ◽  
Kidney Transplant Recipient ◽  
Bone Marrow Aspiration ◽  
Rare Condition ◽  
High Dose ◽  
Kidney Transplant Patient ◽  
Kidney Transplant Recipients

Hemophagocytic lymphohistiocytosis (HLH) is an uncommon life-threatening condition caused by an uncontrolled immunological response. It can develop secondary to malignancies, infections, systemic diseases, and immunosuppression. Multiple risk factors may present in kidney transplant recipients; however, the cases of HLH in this population have been described sparsely. We report a case of a 39-year-old female kidney transplant recipient who presented to the hospital nearly 3.5 years after the transplantation with general malaise, recent history of weight loss, fevers, and persistent anemia. Laboratory tests showed pancytopenia, hyperferritinemia, hypertriglyceridemia, and increased activity of lactate dehydrogenase. A bone marrow aspiration revealed hemophagocytosis, which led to the diagnosis of HLH. Therapy consisting of high-dose steroids and plasma exchanges was administered, resulting in a significant improvement of blood count parameters and the patient’s general condition. While searching for the triggering disease, a single cavitary lesion in the right lung was revealed in a chest radiograph. Computed tomography scan, bronchoscopy, and additional laboratory testing did not reveal a definitive cause of the lesion. We suspect that the lesion may be a consequence of HLH. The patient was disqualified from thoracic surgery due to multiple comorbidities. Even though HLH is a rare condition, it should be taken into consideration in a kidney transplant patient presenting with unspecific symptoms accompanied by a bicytopenia. It has an unpredictable course that often results in serious complications. Thus close follow-up of the patient and a wide array of imaging and laboratory tests remain crucial.

Cytomegalovirus Retinitis Diagnosis and Treatment in a Kidney Transplant Recipient

2019 ◽  
Vol 19 ◽  
Author(s):  
Victoria Oakes ◽  
Dinesh Bahl ◽  
Suresh Antony
Keyword(s):  
Case Report ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Transplant Patient ◽  
Kidney Transplant Recipient ◽  
Diagnosis And Treatment ◽  
Kidney Transplant Patient ◽  
Intravenous Ganciclovir ◽  
Cmv Retinitis ◽  
Appropriate Treatment

: Cytomegalovirus (CMV) retinitis in a kidney transplant recipient is a rare illness with only one other reported case in the literature.. We present a case of a 70-year-old kidney transplant recipient female who presented complaining of decreased vision of her right eye. She was diagnosed with CMV retinitis and started on intravenous ganciclovir. After three weeks of therapy, the patient has had no signs of CMV retinitis.. With only one other previous case report of CMV retinitis in a kidney transplant patient, appropriate treatment and predictability of recurrence are unknown.

Powassan Virus Infection Likely Acquired Through Blood Transfusion Presenting as Encephalitis in a Kidney Transplant Recipient

2020 ◽  
Author(s):  
Lindsay Taylor ◽  
Taryn Condon ◽  
Eric M Destrampe ◽  
Jennifer A Brown ◽  
Jeanette McGavic ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Virus Infection ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Transplant Patient ◽  
Kidney Transplant Recipient ◽  
Kidney Transplant Patient ◽  
Powassan Virus

Abstract A kidney transplant patient without known tick exposure developed encephalitis 3 weeks after transplantation. During the transplant hospitalization, the patient had received a blood transfusion from an asymptomatic donor later discovered to have been infected with Powassan virus. Here, we describe a probable instance of transfusion-transmitted Powassan virus infection.

Antiviral activity of sirolimus in an HIV-positive kidney transplant recipient

2019 ◽  
Vol 30 (9) ◽  
pp. 919-922 ◽  
Author(s):  
Gaetano Alfano ◽  
Francesco Fontana ◽  
Giacomo Mori ◽  
Emanuela Vicari ◽  
Giovanni Dolci ◽  
...  
Keyword(s):  
Side Effects ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Graft Function ◽  
Immunosuppressive Agent ◽  
Hiv Positive ◽  
Antiviral Effects ◽  
Hiv 1

Sirolimus (SIR) is a potent immunosuppressive agent with multiple proprieties. We report beneficial antiviral effects of SIR in an HIV-positive kidney transplant recipient who experienced low-level HIV-1 replication. The immunosuppressive agent was well tolerated by the patient, and no side effects were reported during follow-up. Despite immunosuppressive monotherapy, SIR ensured stable graft function.

scholarly journals Severe COVID-19 infection in a kidney transplant recipient treated with lopinavir/ritonavir, hydroxychloroquine and dexamethasone

2021 ◽  
Vol 15 (09) ◽  
pp. 1257-1262
Author(s):  
Satriyo Dwi Suryantoro ◽  
Mochammad Thaha ◽  
Pranawa ◽  
Djoko Santoso ◽  
Nunuk Mardiana ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Transplant Rejection ◽  
Immunosuppressive Agents ◽  
Immunosuppressive Agent ◽  
Immunosuppressive Drugs ◽  
Renal Transplant Recipients ◽  
Mechanically Ventilated ◽  
Risk And Benefit

Severe COVID-19 infection management for a recipient of kidney transplant has debatable prognosis and treatment. We described the case of a COVID-19 infected 70 year old female, previously had renal transplantation in 2017. The patient took immunosuppressive agents as routine drugs for transplant recipient status and received lopinavir/ritonavir, hydroxychloroquine, and dexamethasone daily at the hospitalization. Specific question arises about renal transplant recipients being infected by COVID-19 – whether the infection will get worse compared to those without immunosuppresive agent. In this case, author decided to stop the immunosuppressive agent followed administration of combination lopinavir/ritonavir, hydroxychloroquine, and dexamethasone that gives a good clinical impact change to patient’s condition after once getting worsened and mechanically ventilated. Nevertheless, the assessment of risk and benefit in continuing immunosuppressive drugs is concurrently essential due to the prevention of transplant rejection.

Recurrent Postoperative Toxic Shock Syndrome in a Living Kidney Transplant Recipient

2020 ◽  
pp. 000313482094521
Author(s):  
Sadaf Aslam ◽  
Jacentha Buggs ◽  
Ebonie Rogers ◽  
Victor Bowers
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Toxic Shock Syndrome ◽  
Kidney Transplant Recipient ◽  
Human Leukocyte ◽  
Kidney Transplant Patient ◽  
Toxic Shock ◽  
Ischemic Time ◽  
Cold Ischemic Time ◽  
History Of

Recurrent toxic shock syndrome (TSS) is uncommon. A certain level of clinical suspicion is indicated with a complex sepsis presentation in the postoperative kidney transplant patient. We present a case of presumed recurrent postoperative TSS in a living kidney transplant recipient. The patient was a 19-year-old Caucasian female with a 4-year prior single episode of toxin-mediated sepsis and chronic kidney disease (CKD) secondary to autosomal recessive Alport’s syndrome (confirmed via renal biopsy and genetic testing). She received a human leukocyte antigen (HLA) 2A 2B 1DR MM, CMV -D/-R kidney from her 21-year-old friend. The patient received Campath and IV steroid induction after total cold ischemic time of 170 minutes with 40 minutes of revascularization. On postoperative day (POD) 5, she required re-exploration with reimplantation and stenting of the transplanted ureter. The patient subsequently spiked a fever of 101.6° with a generalized rash prompting collection of blood cultures which demonstrated no growth. Infectious Disease was consulted due to persistent fevers despite IV antibiotics. On POD 12, the patient returned to the operating room (OR) for evacuation of hematoma after decline in Hgb to 5.8 and CT confirmed perinephric hematomas. Kidney biopsy showed no rejection and donor specific antibodies (DSAs) were unremarkable. The patient underwent 1 treatment of empiric plasmapheresis for possible non-HLA antibodies followed by initiation of clindamycin. The patient’s condition improved, and she was discharged home with a normal creatinine. Recurrent TSS is rare but should be added to the differential diagnoses of immuno-compromised patients undergoing kidney transplantation with a history of prior toxin-mediated sepsis.

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