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. 2022 Mar 21:35:10127.
doi: 10.3389/ti.2022.10127. eCollection 2022.

SARS-CoV-2 Infection Can Lead to an Increase in Tacrolimus Levels in Renal Transplant Patients: A Cohort Study

Christopher G Chalklin  1 , Georgios Koimtzis  1 , Usman Khalid  1   2 , Eliot Carrington-Windo  1 , Doruk Elker  1 , Argiris Asderakis  1   2
Affiliations

SARS-CoV-2 Infection Can Lead to an Increase in Tacrolimus Levels in Renal Transplant Patients: A Cohort Study

Christopher G Chalklin et al. Transpl Int. .

Abstract

The aim of this study is to evaluate the effect of SARS-CoV-2 infection on serum tacrolimus levels. Tacrolimus levels of 34 transplant patients diagnosed with SARS-CoV-2 in 2020 were compared with their pre-infection values and those of a control group with alternative infections. 20 out of 34 (59%) had high levels. At diagnosis, median tacrolimus level in the SARS-CoV-2 cohort was 9.6 μg/L (2.7-23) compared to 7.9 μg/L in the control group (p = 0.07, 95% CI for difference -0.3-5.8). The ratio of post-infection to pre-infection tacrolimus values was higher in the SARS-CoV-2 group (1.7) compared to the control group (1.25, p = 0.018, 95% CI for difference 0.08-0.89). The acute kidney injury rate was 65% (13 of 20) in SARS-CoV-2 patients with a level >8 μg/dl, compared to 29% (4 of 14) in those with lower levels (p = 0.037). Median length of stay was 10 days among SARS-CoV-2 infected patients with high tacrolimus levels compared to 0 days in the rest (p = 0.04). Four patients with high levels died compared to 2 in the control group. Clinicians should be aware of this potential effect on tacrolimus levels and take appropriate measures.

Keywords: AKI; SARS-CoV-2; immunosuppression; kidney transplantation; tacrolimus; tacrolimus levels.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Post to Pre-Infection Tacrolimus Level Ratio. Post to Pre infection Tacrolimus level ratios were higher in patients with SARS- CoV-2 infection (1.7 μg/L) at the time of diagnosis compared to transplant patients admitted with other infections (1.25 μg/L) (p = 0.018, mean ratio difference 0.49, 95% CI 0.08–0.89).
See this image and copyright information in PMC

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