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

  • Thanawat Vongchaiudomchoke Renal Unit, Department of Internal Medicine, Lampang Hospital, Lampang, Thailand https://orcid.org/0000-0002-1007-907X
  • Vittawin Sawangduan Renal Unit, Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
  • Tosapon Sinpanee Renal Unit, Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
  • Nipon Chalermphunchai Pulmonology and Critical Care Unit, Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
  • Kumtorn Lelamali Division of Nephrology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand https://orcid.org/0000-0001-6059-3555
  • Kajohnsak Noppakun Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand https://orcid.org/0000-0002-5783-8766
Keywords: calcineurin inhibitors, drug interaction, immunosuppressive adjustment, immunosuppressive regimen, kidney transplantation, pneumonia, COVID‐19

Abstract

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.

Published
2021-09-30
How to Cite
1.
Vongchaiudomchoke T, Sawangduan V, Sinpanee T, ChalermphunchaiN, Lelamali K, Noppakun K (2021) Modification of immunosuppressive agents in a kidney transplant recipient with COVID-19 and acute kidney injury. J Infect Dev Ctries 15:1273-1276. doi: 10.3855/jidc.13176
Section
Coronavirus Pandemic