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Fatal Lactic Acidosis in a Kidney Transplant Recipient on Combination Antiretroviral Therapy after Initiation of Tacrolimus Therapy
Joint Authors
Hilton, Rachel
Wong, Terry
Lucas, Sebastian B.
Kulasegaram, Ranjababu
Holmes, Michael V.
Source
Case Reports in Transplantation
Issue
Vol. 2011, Issue 2011 (31 Dec. 2011), pp.1-6, 6 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2012-01-05
Country of Publication
Egypt
No. of Pages
6
Main Subjects
Abstract EN
In general, kidney transplantation is safe and efficacious in patients receiving treatment for HIV.
Although multiple drug interactions between antiviral and immunosuppressive treatments exist, few patients experience serious adverse reactions.
We report a case of fatal lactic acidosis in a healthy kidney transplant recipient with stable HIV infection who had previously received treatment for and cleared hepatitis C virus infection.
Death occurred less than one month following the initiation of tacrolimus therapy.
Based on predicted drug interactions, appropriate tacrolimus dosing was calculated prior to its commencement, yet plasma tacrolimus levels were initially unexpectedly high.
The patient subsequently developed lactic acidosis and hepatic steatosis, presumably due to mitochondrial toxicity from the antiretroviral regimen on which he had previously been stable.
We suspect CYP2C19*2 (poor metaboliser) genotype status and concomitant treatment with lansoprazole, tacrolimus, and antiretroviral (ARV) medications resulted in hepatic decompensation.
This highlights the importance of careful interaction screening for all new drugs administered to patients with HIV who have complex treatment regimens as well as heightened clinical vigilance for unexpected toxicities.
American Psychological Association (APA)
Holmes, Michael V.& Kulasegaram, Ranjababu& Lucas, Sebastian B.& Wong, Terry& Hilton, Rachel. 2012. Fatal Lactic Acidosis in a Kidney Transplant Recipient on Combination Antiretroviral Therapy after Initiation of Tacrolimus Therapy. Case Reports in Transplantation،Vol. 2011, no. 2011, pp.1-6.
https://search.emarefa.net/detail/BIM-454812
Modern Language Association (MLA)
Holmes, Michael V.…[et al.]. Fatal Lactic Acidosis in a Kidney Transplant Recipient on Combination Antiretroviral Therapy after Initiation of Tacrolimus Therapy. Case Reports in Transplantation No. 2011 (2011), pp.1-6.
https://search.emarefa.net/detail/BIM-454812
American Medical Association (AMA)
Holmes, Michael V.& Kulasegaram, Ranjababu& Lucas, Sebastian B.& Wong, Terry& Hilton, Rachel. Fatal Lactic Acidosis in a Kidney Transplant Recipient on Combination Antiretroviral Therapy after Initiation of Tacrolimus Therapy. Case Reports in Transplantation. 2012. Vol. 2011, no. 2011, pp.1-6.
https://search.emarefa.net/detail/BIM-454812
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-454812