Clinical Chemistry - Case Study

Perplexingly High Tacrolimus Concentrations in a Renal Transplant Patient with HIV


A 56-year-old female with end-stage renal disease from HIV nephropathy was admitted for a kidney transplant. She was previously on hemodialysis 3 days per week for 6 years prior to admission. Other complications included a history of type 2 diabetes, pancreatitis, cytomegalovirus gastritis, deep vein thrombosis, and hypertension. Her medications included various HIV therapies (i.e., abacavir, dolutegravir, ritonavir, and darunavir), erythropoietin due to kidney dysfunction, as well as irbesartan, an angiotensin II receptor antagonist, and amlodipine, a calcium channel blocker, both to treat hypertension. Her laboratory results the morning of her transplant were typical of a patient with end-stage renal disease.