Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Nov 28, 2020; 10(11): 365-371
Published online Nov 28, 2020. doi: 10.5500/wjt.v10.i11.365
COVID-19 infection in a kidney transplant recipient—special emphasis on pharmacokinetic interactions: A case report
Ebru Gok Oguz, Kadir Gokhan Atilgan, Sanem Guler Cimen, Hatice Sahin, Tamer Selen, Fatma Ayerden Ebinc, Sertac Cimen, Mehmet Deniz Ayli
Ebru Gok Oguz, Department of Nephrology, Diskapi Yildirim Beyazit Training and Res Hosp, Ankara 6500, Turkey
Kadir Gokhan Atilgan, Hatice Sahin, Tamer Selen, Fatma Ayerden Ebinc, Department of Nephrology, Health Sciences University, Ankara 6500, Turkey
Sanem Guler Cimen, Department of General Surgery, Diskapi Research and Training Hospital, Health Sciences University, Ankara 65000, Select One, Turkey
Sertac Cimen, Department of Urology and Transplantation, Health Sciences University, Ankara 65000, Select One, Turkey
Mehmet Deniz Ayli, Department of Nephrology and Transplantation, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara 6500, Turkey
Author contributions: Oguz EG, Atilgan KG and Cimen SG reviewed the patient’s chart and the clinical literature; Sahin H, Selen T and Ebinc FA wrote the manuscript; Cimen S and Ayli MD supervised the patient management and revised the manuscript.
Informed consent statement: Informed consent was obtained from the patient and a scanned copy has been provided with the submission documents.
Conflict-of-interest statement: The authors have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: 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. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sanem Guler Cimen, FEBS, MD, MSc, Associate Professor, Attending Doctor, Director, Surgeon, Department of General Surgery, Diskapi Research and Training Hospital, Health Sciences University, Guvenlik Caddesi No. 87-6, Ankara 65000, Select One, Turkey. s.cimen@dal.ca
Received: July 26, 2020
Peer-review started: July 26, 2020
First decision: October 21, 2020
Revised: October 28, 2020
Accepted: November 5, 2020
Article in press: November 5, 2020
Published online: November 28, 2020
Abstract
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.

Keywords: COVID-19, Kidney transplantation, Drug interaction, Pharmacokinetics, Azithromycin, Case report, Calcineurin inhibitor

Core Tip: This case report is illustrative for dilemmas experienced by transplant professionals while managing kidney transplant recipients with coronavirus disease 2019 (COVID-19). By reporting this case, we intend to create awareness of drug interactions observed in renal transplant recipients with COVID-19.