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

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.

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Muir–Torre syndrome: sebaceous carcinoma concurrent with colon cancer in a kidney transplant recipient; a case report

BMC Nephrology ◽

10.1186/s12882-019-1592-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Masahiro Tomonari ◽

Mariko Shimada ◽

Yasuyuki Nakada ◽

Izumi Yamamoto ◽

Munenari Itoh ◽

...

Keyword(s):

Colon Cancer ◽

Case Report ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Immunosuppressive Agents ◽

Genetic Mutation ◽

Sebaceous Carcinoma ◽

Transplant Recipients ◽

Kidney Transplant Recipients

Abstract Background Sebaceous carcinoma is a rare but progressive malignant skin cancer, and the incidence is approximately five times higher in post-transplant patients than in people who have not received kidney transplants. Sebaceous carcinoma is sometimes found concurrently with visceral cancers and a genetic abnormality, Muir–Torre syndrome. We report the case of a female kidney transplant recipient with sebaceous carcinoma concurrent with colon cancer 10 years after transplantation. Case presentation A 43-year-old woman was admitted due to a rapidly progressive tumor on her head. Histologically, the tumor was diagnosed as sebaceous carcinoma. We diagnosed her with Muir–Torre syndrome based on the following evidence: 1) high prevalence of microsatellite instability in gene locus assay, 2) absence of mismatch repair proteins in the sebaceous carcinoma on immunohistochemical analysis, and 3) a genetic mutation of 1226_1227delAG in the MSH2 exon 7 in the lesion detected by DNA sequencing analysis. Several reports have shown an association between immunosuppressive agents and latent Muir–Torre syndrome progression. Therefore, the progression of colon cancer in this case originated from her genetic mutation for Muir–Torre syndrome and long-term use of immunosuppressive agents. Conclusion This case report not only highlights the importance of adequate diagnosis and therapy for Muir–Torre syndrome, but also suggests the further prevention of the development of malignant tumors in kidney transplant recipients. Physicians should be mindful that sebaceous carcinoma in kidney transplant recipients is highly concurrent with Muir–Torre syndrome.

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Long-Term Clinical and Immunological Impact of Severe COVID-19 on a Living Kidney Transplant Recipient – A Case Report

Frontiers in Immunology ◽

10.3389/fimmu.2021.741765 ◽

2021 ◽

Vol 12 ◽

Author(s):

Liru Qiu ◽

Ji Zhang ◽

Yafei Huang ◽

Gen Chen ◽

Zhishui Chen ◽

...

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Clinical Decision Making ◽

Kidney Transplant Recipient ◽

Transplant Rejection ◽

Clinical Decision ◽

Renal Tubular Cells ◽

Renal Tubular ◽

Long Term Impact

The long-term impact of COVID-19 on transplant recipients remains unknown. We describe the case of a 30-year-old male kidney transplant recipient from Wuhan, China that was treated for severe COVID-19 in February 2020. He suffered an acute lung and renal injury and required systemic treatment including adjustment of his immunosuppressant regime. He was followed up to 1-year after discharge. No chronic lung fibrosis or deterioration of his pulmonary function was observed. Despite COVID-19 mediated damage to his renal tubular cells, no transplant rejection occurred. His immunological profile demonstrated both cellular anti-SARS-CoV-2 reactivity and specific humoral immunity, indicating that it is beneficial for the transplanted patients to be immunized with SARS-CoV-2 virus vaccine. This case will help guide clinical decision making for immunocompromised individuals that become infected with SARS-CoV-2.

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

International Journal of STD & AIDS ◽

10.1177/0956462419839520 ◽

2019 ◽

Vol 30 (9) ◽

pp. 919-922 ◽

Cited By ~ 2

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.

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BK polyoma virus nephropathy in kidney transplant recipient: the role of new immunosuppressive agents

Transplantation Proceedings ◽

10.1016/s0041-1345(03)00006-x ◽

2003 ◽

Vol 35 (2) ◽

pp. 604-605 ◽

Cited By ~ 27

Author(s):

R Rahamimov ◽

S Lustig ◽

A Tovar ◽

A Yussim ◽

N Bar-Nathan ◽

...

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Immunosuppressive Agents ◽

Polyoma Virus

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Modification of immunosuppressive agents in a kidney transplant recipient with COVID-19 and acute kidney injury

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13176 ◽

2021 ◽

Vol 15 (09) ◽

pp. 1273-1276

Author(s):

Thanawat Vongchaiudomchoke ◽

Vittawin Sawangduan ◽

Tosapon Sinpanee ◽

Nipon Chalermphunchai ◽

Kumtorn Lelamali ◽

...

Keyword(s):

Acute Kidney Injury ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Immunosuppressive Agents ◽

Organ Transplant ◽

Kidney Injury ◽

Limited Data ◽

Organ Rejection ◽

Calcineurin Inhibitor Nephrotoxicity

Introduction: An outbreak of coronavirus disease-19 (COVID-19) has occurred in different parts of the world. Although a large piece of information regarding the epidemiology, clinical features, and management of COVID-19 has been reported in the general population, there is very limited data regarding organ transplant recipients, particularly regarding the management of maintenance immunosuppressive agents during infection. Methodology: We described a case of kidney transplant recipient from Thailand who had COVID-19 pneumonia and severe acute kidney injury. Results: The patient’s serum creatinine peaked at 7.0 mg/dL on day 15 of illness and returned to baseline value of 2.0 mg/dL on day 26 of illness. We have shown how we modified tacrolimus, mycophenolate, and steroids in the patient who had received favipiravir and lopinavir/ritonavir for COVID-19 pneumonia. Conclusions: In this case, successful modification of this immunosuppressive regimen was accomplished to reduce drug interaction complications, aiming to avoid calcineurin inhibitor nephrotoxicity while maintaining appropriate levels of immunosuppression to prevent organ rejection and to promote the patient’s recovery from infection.

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