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Rotavirus infection as cause of tacrolimus elevation in solid-organ-transplanted children

M Frühwirth1, H Fischer, B Simma

  • 1Department of Pediatrics, Department of Transplantation Surgery, School of Medicine, University of Innsbruck, Anichstrasse 356, A-6020 Innsbruck, Austria. Martin.Fruehwirth@uibk.ac.at

Pediatric Transplantation
|May 1, 2001
PubMed

Insights

Rotavirus (RV) infection can increase tacrolimus (TAC) levels in organ transplant recipients. Early reduction of TAC dosage is recommended during acute gastroenteritis in these patients.

Area of Science:

  • Immunology
  • Virology
  • Pharmacology

Background:

  • Rotavirus (RV) is a leading cause of diarrheal illness in pediatric populations.
  • Solid-organ transplant (SOT) recipients require immunosuppressive therapy, such as tacrolimus (TAC), to prevent rejection.
  • Understanding drug-interactions in immunocompromised patients is crucial for effective management.

Observation:

  • Three SOT patients experienced elevated tacrolimus (TAC) trough levels during rotavirus (RV) infection.
  • RV was detected in feces for extended periods in these immunosuppressed patients compared to non-immunosuppressed infants.
  • The precise mechanisms driving TAC level increases during RV infection remain under investigation.

Findings:

  • Rotavirus infection is associated with significantly increased blood trough levels of tacrolimus in solid-organ transplant recipients.
  • Persistent fecal shedding of RV observed in transplant patients suggests altered viral kinetics under immunosuppression.
  • The study highlights a potential drug-virus interaction impacting tacrolimus pharmacokinetics.

Implications:

  • Close monitoring of tacrolimus (TAC) blood trough levels is essential in solid-organ transplant recipients presenting with acute gastroenteritis.
  • Prompt dosage reduction of TAC may be necessary to prevent toxicity during rotavirus infections.
  • Further research is warranted to elucidate the mechanisms behind rotavirus-induced alterations in tacrolimus metabolism or transport.

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