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COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report
BACKGROUND: Solid organ transplant recipients are considered to be at high-risk of developing coronavirus disease 2019 (COVID-19)-related complications. The optimal treatment for this patient group is unknown. Consequently, the treatment of COVID-19 in kidney transplant recipients should be determin...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708882/ https://www.ncbi.nlm.nih.gov/pubmed/33312897 http://dx.doi.org/10.5500/wjt.v10.i11.365 |
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author | Oguz, Ebru Gok Atilgan, Kadir Gokhan Cimen, Sanem Guler Sahin, Hatice Selen, Tamer Ebinc, Fatma Ayerden Cimen, Sertac Ayli, Mehmet Deniz |
author_facet | Oguz, Ebru Gok Atilgan, Kadir Gokhan Cimen, Sanem Guler Sahin, Hatice Selen, Tamer Ebinc, Fatma Ayerden Cimen, Sertac Ayli, Mehmet Deniz |
author_sort | Oguz, Ebru Gok |
collection | PubMed |
description | BACKGROUND: Solid organ transplant recipients are considered to be at high-risk of developing coronavirus disease 2019 (COVID-19)-related complications. The optimal treatment for this patient group is unknown. Consequently, the treatment of COVID-19 in kidney transplant recipients should be determined individually, considering patient age and comorbidities, as well as graft function, time of transplant, and immunosuppressive treatment. Immunosuppressive treatments may give rise to severe COVID-19. On the contrary, they may also lead to a milder and atypical presentation by diminishing the immune system overdrive. CASE SUMMARY: A 50-year old female kidney transplant recipient presented to the transplant clinic with a progressive dry cough and fever that started three days ago. Although the COVID-19 test was found to be negative, chest computed tomography images showed consolidation typical of the disease; thus, following hospital admission, anti-bacterial and COVID-19 treatments were initiated. However, despite clinical improvement of the lung consolidation, her creatinine levels continued to increase. Ultrasound of the graft showed no pathology. The tacrolimus blood level was determined and the elevation in creatinine was found to be related to an interaction between tacrolimus and azithromycin. CONCLUSION: During the COVID-19 pandemic, various single or combination drugs have been utilized to find an effective treatment regimen. This has increased the possibility of drug interactions. A limited number of studies published in the literature have highlighted some of these pharmacokinetic interactions. Treatments used for COVID-19 therapy; azithromycin, atazanavir, lopinavir/ritonavir, remdesivir, favipiravir, chloroquine, hydroxychloroquine, nitazoxanide, ribavirin, and tocilizumab, interact with immunosuppressive treatments, most importantly with calcineurin inhibitors. Thus, their levels should be frequently monitored to prevent toxicity. |
format | Online Article Text |
id | pubmed-7708882 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-77088822020-12-11 COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report Oguz, Ebru Gok Atilgan, Kadir Gokhan Cimen, Sanem Guler Sahin, Hatice Selen, Tamer Ebinc, Fatma Ayerden Cimen, Sertac Ayli, Mehmet Deniz World J Transplant Case Report BACKGROUND: Solid organ transplant recipients are considered to be at high-risk of developing coronavirus disease 2019 (COVID-19)-related complications. The optimal treatment for this patient group is unknown. Consequently, the treatment of COVID-19 in kidney transplant recipients should be determined individually, considering patient age and comorbidities, as well as graft function, time of transplant, and immunosuppressive treatment. Immunosuppressive treatments may give rise to severe COVID-19. On the contrary, they may also lead to a milder and atypical presentation by diminishing the immune system overdrive. CASE SUMMARY: A 50-year old female kidney transplant recipient presented to the transplant clinic with a progressive dry cough and fever that started three days ago. Although the COVID-19 test was found to be negative, chest computed tomography images showed consolidation typical of the disease; thus, following hospital admission, anti-bacterial and COVID-19 treatments were initiated. However, despite clinical improvement of the lung consolidation, her creatinine levels continued to increase. Ultrasound of the graft showed no pathology. The tacrolimus blood level was determined and the elevation in creatinine was found to be related to an interaction between tacrolimus and azithromycin. CONCLUSION: During the COVID-19 pandemic, various single or combination drugs have been utilized to find an effective treatment regimen. This has increased the possibility of drug interactions. A limited number of studies published in the literature have highlighted some of these pharmacokinetic interactions. Treatments used for COVID-19 therapy; azithromycin, atazanavir, lopinavir/ritonavir, remdesivir, favipiravir, chloroquine, hydroxychloroquine, nitazoxanide, ribavirin, and tocilizumab, interact with immunosuppressive treatments, most importantly with calcineurin inhibitors. Thus, their levels should be frequently monitored to prevent toxicity. Baishideng Publishing Group Inc 2020-11-28 2020-11-28 /pmc/articles/PMC7708882/ /pubmed/33312897 http://dx.doi.org/10.5500/wjt.v10.i11.365 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Case Report Oguz, Ebru Gok Atilgan, Kadir Gokhan Cimen, Sanem Guler Sahin, Hatice Selen, Tamer Ebinc, Fatma Ayerden Cimen, Sertac Ayli, Mehmet Deniz COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report |
title | COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report |
title_full | COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report |
title_fullStr | COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report |
title_full_unstemmed | COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report |
title_short | COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report |
title_sort | covid-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708882/ https://www.ncbi.nlm.nih.gov/pubmed/33312897 http://dx.doi.org/10.5500/wjt.v10.i11.365 |
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