title: Immunologic and Pharmacologic Aspects in an Elderly Recipient of Liver Transplant With Pulmonary Aspergillosis and Multiple Comorbidities.
abstract: The net state of immunosuppression, the occurrence of infections, drug-drug interactions, and toxicity can compromise the outcome of liver transplant recipients with multiple comorbidities. We present a 67-year-old man who developed early posttransplant severe chronic obstructive pulmonary disease exacerbation, pulmonary aspergillosis, and cytomegalovirus reactivation. Drug-drug interactions between azoles and cyclosporine, along with renal and liver toxicity, required adjustments in dosage. Interferon-gamma production from antigen-stimulated T cells was recorded. Early diagnosis and treatment, along with therapeutic drug monitoring and recovery of T-cell immunity, were key factors for a positive outcome.
authors.affiliation: From the Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Italy.
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
authors.forename: Federico
authors.initials: F
authors.lastname: Ivaldi
authors.forename: Alessia
authors.initials: A
authors.lastname: Carnelutti
authors.forename: Ludmila
authors.initials: L
authors.lastname: Tomkova
authors.forename: Giovanni
authors.initials: G
authors.lastname: Villa
authors.forename: Assunta
authors.initials: A
authors.lastname: Sartor
authors.forename: Giorgio
authors.initials: G
authors.lastname: Soardo
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Federico
authors.initials: F
authors.lastname: Pea
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
mesh_terms: D000367:Age Factors; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects; D000998:Antiviral Agents / Q000009:adverse effects; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000276:immunology / Q000821:virology; D004347:Drug Interactions; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology*; D055732:Pulmonary Aspergillosis / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology*; D012307:Risk Factors; D018417:Th1 Cells / Q000187:drug effects / Q000276:immunology / Q000382:microbiology / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000935:Antifungal Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents