Threatening drug-drug interaction in a kidney transplant patient with coronavirus disease 2019 (COVID-19)

Transpl Infect Dis. 2020 Aug;22(4):e13286. doi: 10.1111/tid.13286. Epub 2020 Jul 14.

Abstract

During the novel coronavirus pandemic, organ transplant recipients represent a frail susceptible category due to long-term immunosuppressive therapy. For this reason, clinical manifestations may differ from general population and different treatment approaches may be needed. We present the case of a 36-year-old kidney-transplanted woman affected by Senior-Loken syndrome diagnosed with COVID-19 pneumonia after a contact with her positive mother. Initial symptoms were fatigue, dry cough, and coryza; she never had fever nor oxygen supplementation. Hydroxychloroquine and lopinavir/ritonavir were started, and the antiviral drug was replaced with darunavir/cobicistat after 2 days for diarrhea. Immunosuppressant levels were closely monitored, and we observed very high tacrolimus trough levels despite initial dose reduction. The patient was left with steroid therapy alone. The peculiarity of clinical presentation and the management difficulties represent the flagship of our case report. We stress the need for guidelines in transplant recipients with COVID-19 infection with particular regard to the management of therapy.

Keywords: COVID-19; drug-drug interaction; kidney transplant.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antiviral Agents / adverse effects*
  • Antiviral Agents / therapeutic use
  • Betacoronavirus
  • C-Reactive Protein / immunology
  • COVID-19
  • Ciliopathies / complications
  • Cobicistat / therapeutic use
  • Common Cold / etiology
  • Common Cold / physiopathology
  • Coronavirus Infections / complications
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / immunology
  • Coronavirus Infections / physiopathology
  • Cough / etiology
  • Cough / physiopathology
  • Cytochrome P-450 CYP3A Inhibitors / adverse effects*
  • Darunavir / therapeutic use
  • Deprescriptions
  • Drug Combinations
  • Drug Interactions
  • Enzyme Inhibitors / therapeutic use
  • Fatigue / etiology
  • Fatigue / physiopathology
  • Female
  • Glucocorticoids / therapeutic use
  • Graft Rejection / prevention & control*
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunocompromised Host / immunology
  • Immunosuppressive Agents / adverse effects*
  • Interleukin-10 / immunology
  • Interleukin-1beta / immunology
  • Interleukin-6 / immunology
  • Interleukin-8 / immunology
  • Kidney Diseases, Cystic / complications
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation*
  • Leber Congenital Amaurosis / complications
  • Lopinavir / adverse effects*
  • Methylprednisolone / therapeutic use
  • Optic Atrophies, Hereditary / complications
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / physiopathology
  • Ritonavir / adverse effects*
  • SARS-CoV-2
  • Severity of Illness Index
  • Tacrolimus / adverse effects*

Substances

  • Antiviral Agents
  • Cytochrome P-450 CYP3A Inhibitors
  • Drug Combinations
  • Enzyme Inhibitors
  • Glucocorticoids
  • Immunosuppressive Agents
  • Interleukin-1beta
  • Interleukin-6
  • Interleukin-8
  • lopinavir-ritonavir drug combination
  • Interleukin-10
  • Lopinavir
  • Hydroxychloroquine
  • C-Reactive Protein
  • Cobicistat
  • Ritonavir
  • Tacrolimus
  • Methylprednisolone
  • Darunavir

Supplementary concepts

  • COVID-19 drug treatment
  • Senior Loken Syndrome