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Case Reports
. 2020 Jul;20(7):1896-1901.
doi: 10.1111/ajt.15943. Epub 2020 May 13.

Severe COVID-19 in a renal transplant recipient: A focus on pharmacokinetics

Soufian Meziyerh  1   2 , Tom C Zwart  3 , Ronald W van Etten  4 , Jeroen A Janson  5 , Teun van Gelder  3 , Ian P J Alwayn  2   6 , Johan W de Fijter  1   2 , Marlies E J Reinders  1   2 , Dirk J A R Moes  3 , Aiko P J de Vries  1   2
Affiliations
Case Reports

Severe COVID-19 in a renal transplant recipient: A focus on pharmacokinetics

Soufian Meziyerh et al. Am J Transplant. 2020 Jul.

Abstract

The current coronavirus disease 2019 (COVID-19) pandemic requires extra attention for immunocompromised patients, including solid organ transplant recipients. We report on a case of a 35-year-old renal transplant recipient who suffered from a severe COVID-19 pneumonia. The clinical course was complicated by extreme overexposure to the mammalian target of rapamycin inhibitor everolimus, following coadministration of chloroquine and lopinavir/ritonavir therapy. The case is illustrative for dilemmas that transplant professionals may face in the absence of evidence-based COVID-19 therapy and concurrent pressure for exploration of experimental pharmacological treatment options. However, the risk-benefit balance of experimental or off-label therapy may be weighed differently in organ transplant recipients than in otherwise healthy COVID-19 patients, owing to their immunocompromised status and potential drug interactions with immunosuppressive therapy. With this case report, we aimed to achieve increased awareness and improved management of drug-drug interactions associated with the various treatment options for COVID-19 in renal transplant patients.

Keywords: clinical decision-making; clinical research/practice; drug interaction; immunosuppressive regimens; infection and infectious agents - viral; infectious disease; kidney transplantation/nephrology; pharmacokinetics/pharmacodynamics; pharmacology.

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Figures

FIGURE 1
FIGURE 1
Schematic depiction of the course of everolimus concentrations since (A) the transplantation procedure and (B) the onset of coronavirus disease 2019 (COVID-19)–related symptoms. The gray-shaded area depicts the everolimus trough target range, with the period of hospital admission indicated in red. The timing of essential aspects of this case report are indicated with arrows. COVID-19, coronavirus disease 2019; AVT, antiviral therapy; EVL, everolimus; CSA, cyclosporine [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
A, Sitting anteroposterior chest radiograph on March 10, 2020, showing peripheral localized consolidations in multiple lobes in the lung suspicious for a viral pathogen. B, Supine anteroposterior chest radiograph on March 14, 2020, showing progressive, peripheral, and bilateral consolidations, primarily in the right upper lobe
See this image and copyright information in PMC

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