{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T04:20:51Z","timestamp":1789791651869,"version":"4.0.1"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Solid organ transplant (SOT) recipients are at risk of complications from COVID\u201019. Nirmatrelvir\/ritonavir (Paxlovid) can reduce mortality from COVID\u201019 but is contraindicated in patients receiving calcineurin inhibitors (CI), which depend on cytochrome p4503A (CY3PA). In this study, we aim to show the feasibility of nirmatrelvir\/ritonavir administration to SOT recipients receiving CI with coordination of medication management and limited tacrolimus trough monitoring.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed adult SOT recipients treated with nirmatrelvir\/ritonavir from 4\/14 to 11\/1\/2022 and assessed for changes in tacrolimus trough and serum creatinine after therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 47 patients identified, 28 were receiving tacrolimus and had follow\u2010up laboratory testing. Patients had a mean age of 55 years, 17 (61%) received a kidney transplant and 23 (82%) received three or more doses of SARS\u2010CoV\u20102 mRNA vaccine. Patients had mild\u2010moderate COVID\u201019 and started nirmatrelvir\/ritonavir within 5 days of symptom onset. Median baseline tacrolimus trough concentration was 5.6\u00a0ng\/mL (Interquartile range 5.1\u20136.7), while median follow\u2010up tacrolimus trough concentration was 7.8\u00a0ng\/mL (Interquartile range 5.7\u201311.5, <jats:italic>p<\/jats:italic> = 0.0017). Median baseline and follow\u2010up serum creatinine levels were 1.21\u00a0mg\/dL (Interquartile range 1.02\u20131.39) and 1.21\u00a0mg\/dL (interquartile range 1.02\u20131.44, <jats:italic>p<\/jats:italic> = 0.3162), respectively. One kidney recipient had a follow up creatinine level &gt;1.5 times baseline. No patients were hospitalized or died from COVID\u201019 in the follow up period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While administration of nirmatrelvir\/ritonavir resulted in a significant increase in tacrolimus concentration, this did not result in significant nephrotoxicity. Early oral antiviral treatment in SOT recipients is feasible with medication management, even with limited tacrolimus trough monitoring.\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tid14037-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.14037","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T13:10:19Z","timestamp":1677503419000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["\u201cSaving lives with nirmatrelvir\/ritonavir one transplant patient at a time\u201d"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2556-3083","authenticated-orcid":false,"given":"Katherine A.","family":"Belden","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5829-7674","authenticated-orcid":false,"given":"Sarah","family":"Yeager","sequence":"additional","affiliation":[{"name":"Department of Transplant Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Schulte","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria P. Martinez","family":"Cantarin","sequence":"additional","affiliation":[{"name":"Division of Nephrology Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Moss","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tricia","family":"Royer","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dagan","family":"Coppock","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Thomas Jefferson University Hospital  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2021.02.014"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003902"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2118542"},{"issue":"1","key":"e_1_2_8_5_1","article-title":"Structural basis for Nirmatrelvir in vitro efficacy against the Omicron variant of SARS\u2010CoV\u20102","volume":"2","author":"Greasley SE","year":"2022","journal-title":"bioRxiv"},{"key":"e_1_2_8_6_1","volume-title":"Fact sheet for healthcare providers Emergency Use Authorization (EUA) of baricitinib","author":"U.S. Food and Drug Administration","year":"2021"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/M22\u20100281"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfs160"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.5530\/ijmedph.2021.3.23"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13111"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2022.01.001"},{"key":"e_1_2_8_12_1","unstructured":"AST.Coronavirus Disease 2019 (COVID\u201019): Frequently Asked Questions for Transplant Candidates Recipients and Care Givers. AST;2019."},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16955"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17027"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16997"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.14037","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tid.14037","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.14037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T21:16:52Z","timestamp":1692652612000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.14037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,27]]},"references-count":14,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1111\/tid.14037"],"URL":"https:\/\/doi.org\/10.1111\/tid.14037","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,27]]},"assertion":[{"value":"2022-10-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14037"}}