Affordable Access

Publisher Website

Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug-Drug Interactions.

  • Elens, Laure1, 2
  • Langman, Loralie J3
  • Hesselink, Dennis A4, 5
  • Bergan, Stein6
  • Moes, Dirk Jan A R7
  • Molinaro, Mariadelfina8
  • Venkataramanan, Raman9
  • Lemaitre, Florian10, 11
  • 1 Louvain Drug Research Institute (LDRI), Integrated Pharmacometrics, Pharmacogenomics and Pharmacokinetics (PMGK), Université catholique de Louvain (UCLouvain), Brussels, Belgium. , (Belgium)
  • 2 Institut de Recherche Expérimentale et Clinique (IREC), Louvain Center for Toxicology and Applied Pharmacology (LTAP), Université catholique de Louvain (UCLouvain), Brussels, Belgium. , (Belgium)
  • 3 Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.
  • 4 Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. , (Netherlands)
  • 5 Rotterdam Transplant Group.
  • 6 Department of Pharmacology, Oslo University Hospital, Oslo, Norway. , (Norway)
  • 7 Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands. , (Netherlands)
  • 8 Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. , (Italy)
  • 9 School of Pharmacy and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 10 Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Rennes, France; and. , (France)
  • 11 INSERM, Centre d'Investigation Clinique, CIC 1414, Rennes, France. , (France)
Published Article
Therapeutic drug monitoring
Publication Date
Jun 01, 2020
DOI: 10.1097/FTD.0000000000000761
PMID: 32304488


COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals. This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature. Management of drug-drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight. With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.

Report this publication


Seen <100 times