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

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.

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Drug Interaction between Sirolimus and Ranolazine in a Kidney Transplant Patient

Case Reports in Transplantation ◽

10.1155/2014/548243 ◽

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.

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Acute kidney injury in an infant of a kidney allograft recipient

Clinical Kidney Journal ◽

10.1093/ckj/sfz093 ◽

2019 ◽

Vol 13 (1) ◽

pp. 123-124

Author(s):

Serkan Aktürk ◽

Rezzan Eren Sadioğlu ◽

Şule Şengül ◽

Kenan Keven

Keyword(s):

Acute Kidney Injury ◽

Transplant Recipient ◽

Whole Blood ◽

Umbilical Vein ◽

Kidney Transplant Recipient ◽

Kidney Injury ◽

Maternal Blood ◽

Blood Levels ◽

Fetal Complications ◽

The Relationship

Abstract Tacrolimus has been used in pregnant organ recipients for >20 years, and the relationship between fetal complications and the amount of tacrolimus crossing the placenta is still controversial. We report the case of a kidney transplant recipient who used tacrolimus and gave birth to an offspring that developed, shortly after birth, an acute kidney injury caused by tacrolimus exposure, which was detected by measuring tacrolimus levels in the umbilical vein, as well as in maternal blood. Even if whole-blood levels of tacrolimus are within the therapeutic range throughout pregnancy, the amount of tacrolimus could reach toxic levels.

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First Reported Case in Romania of a Successfully Treated Severe COVID-19 in a Kidney Transplant Recipient: A Focus on Acute Kidney Injury

Case Reports in Nephrology and Dialysis ◽

10.1159/000512606 ◽

2020 ◽

Vol 10 (3) ◽

pp. 174-179

Author(s):

Flaviu Tosa ◽

Roxana Manaila ◽

Alina Elec ◽

Tudor Moisoiu ◽

Liviu Ghervan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Clinical Status ◽

Organ Transplant ◽

Treatment Strategies ◽

Kidney Injury ◽

Kidney Graft ◽

Kidney Involvement

As coronavirus disease 2019 (COVID-19) caused by the novel virus SARS-CoV-2 is expanding worldwide, kidney involvement seems to be part of the spectrum of its effects. Moreover, the prognosis of the disease seems to be worse in immunocompromised patients when compared to the general population, with 4–5 times higher mortality rates. However, the overall impact on long-term function of the kidney graft is unknown. We report on a case of a 46-year-old kidney transplant recipient who was successfully treated for severe COVID-19 pneumonia. The clinical course was complicated by transient acute kidney injury, most likely due to tubulo-interstitial involvement, with return to the baseline of the creatinine level by the time of discharge. We discuss the characteristics and differential diagnosis of acute kidney injury, as well as management of immunosuppression in connection with overall clinical status and evolution of kidney function. The case is illustrative for dilemmas that transplant professionals may face in the absence of evidence-based, efficient COVID-19 therapy. The risk-benefit balance of the yet to be approved treatment strategies may be weighed differently in organ transplant recipients owing to their immunocompromised status and potential drug interactions with immunosuppressive therapy.

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Acute kidney injury with extreme hyperuricemia after antithymocyte globulin treatment in a kidney transplant recipient with underlying aplastic anemia: a case report

BMC Nephrology ◽

10.1186/s12882-020-01903-9 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Yohan Park ◽

Byung Ha Chung ◽

Cheol Whee Park ◽

Yong-Soo Kim ◽

Chul Woo Yang

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Transplant Recipient ◽

Aplastic Anemia ◽

Kidney Transplant ◽

Antithymocyte Globulin ◽

Kidney Transplant Recipient ◽

Kidney Injury

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Gastric Mucormycosis in a Liver and Kidney Transplant Recipient: Case Report and Concise Review of Literature

Transplantation Proceedings ◽

10.1016/j.transproceed.2017.11.036 ◽

2018 ◽

Vol 50 (3) ◽

pp. 905-909 ◽

Cited By ~ 5

Author(s):

G. Alfano ◽

F. Fontana ◽

D. Francesca ◽

G. Assirati ◽

P. Magistri ◽

...

Keyword(s):

Case Report ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Review Of Literature ◽

Concise Review ◽

Liver And Kidney

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Therapeutic drug monitoring of once-daily tacrolimus (Advagraf) in a gastrectomized kidney transplant recipient

Nephrology ◽

10.1111/nep.12740 ◽

2017 ◽

Vol 22 (2) ◽

pp. 184-184

Author(s):

Terry King-Wing Ma ◽

Kai Ming Chow ◽

Bonnie Ching-Ha Kwan ◽

Chi Bon Leung ◽

Cheuk Chun Szeto ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Transplant Recipient ◽

Kidney Transplant ◽

Drug Monitoring ◽

Kidney Transplant Recipient ◽

Therapeutic Drug ◽

Once Daily

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Skin lesions and acute kidney injury in a kidney transplant recipient

American Journal of Transplantation ◽

10.1111/ajt.16519 ◽

2021 ◽

Vol 21 (6) ◽

pp. 2298-2300

Author(s):

Shai Chazin ◽

Osaid Saqqa ◽

Anil Paramesh ◽

Sixto Giusti

Keyword(s):

Acute Kidney Injury ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Kidney Injury ◽

Skin Lesions

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Acute Renal Failure and Volume Overload Syndrome Secondary to a Femorofemoral Arteriovenous Fistula Angioplasty in a Kidney Transplant Recipient

Case Reports in Transplantation ◽

10.1155/2013/197524 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Dominique Bertrand ◽

Geoffroy Desbuissons ◽

Nicolas Pallet ◽

Albane Sartorius ◽

Christophe Legendre ◽

...

Keyword(s):

Renal Failure ◽

Kidney Transplantation ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Function ◽

Clinical Symptoms ◽

Kidney Transplant Recipient ◽

Volume Overload ◽

Kidney Transplant Recipients ◽

The Impact

Experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation after transplantation modifies hemodynamic parameters and kidney function. We report a case of a renal transplant recipient who developed an acute congestive heart failure accompanied by renal failure, which were triggered by femorofemoral AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. This paper illustrates the potential deleterious consequences of high-output AVF after kidney transplantation and raises considerations regarding the impact of the fistula on cardiac status and kidney function after kidney transplantation and, consequently, the management AVF after transplantation.

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