A challenging male patient with retroviral infection on highly active antiretroviral therapy issues with re-transplantation

Abstract

A 44-year-old African male with chronic kidney disease Stage V due to hypertension underwent a live related renal transplant in 2005. He was on triple immunosuppression postoperatively. Subsequently, he developed metastatic Kaposi sarcoma requiring reduction in immunosuppression and switching over to rapamycin. He was found to be retrovirus positive on a follow-up visit. His graft function progressively deteriorated requiring dialysis while continuing on highly active antiretroviral therapy. He had multiple infective episodes including acute bacterial endocarditis. He received a second renal transplant from a live-related donor in 2017. Despite repeated dosage adjustments, tacrolimus levels were persistently elevated due to drug-drug interaction with diltiazem and anti-retroviral drugs, despite good allograft function.

Keywords

• Calcineurin inhibitor induced allograft dysfunction
• Kaposi sarcoma
• re-grafting
• retroviral infection