Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis

Lianhu Yu; Lu Zheng; Hui Hu; Ping Wan; Yanming Lu; Libo Wang; Hui Yu; Yiwei Chen; Jianguo Zhou; Qiang Xia; Wenhao Zhou; Ting Zhang

doi:10.3389/fmed.2022.972978

Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis

Front Med (Lausanne). 2023 Jan 4:9:972978. doi: 10.3389/fmed.2022.972978. eCollection 2022.

Authors

Lianhu Yu¹, Lu Zheng¹, Hui Hu¹, Ping Wan², Yanming Lu³, Libo Wang⁴, Hui Yu⁵, Yiwei Chen⁶, Jianguo Zhou⁷, Qiang Xia², Wenhao Zhou⁷, Ting Zhang¹

Affiliations

¹ Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
² Department of Liver Transplantation, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³ Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁴ Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai, China.
⁵ Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
⁶ Department of Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁷ Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.

Abstract

Background: The management of LT patients during COVID-19 pandemic is important. Immunosuppressants (IS) are key therapy agents after liver transplant. Different ISs have different side effects. Calcineurin inhibitor (CNI) may lead to metabolic acidosis while mycophenolate mofetil (MMF) showed rare nephrotoxicity. We report a post-liver transplant girl who was infected with SARS-CoV-2, developing a severe mixed acidosis 3 months after the transplantation. Her acidosis was improved after withdrawing of MMF, leading the suspicion that acidosis maybe a rare side effect of MMF.

Case presentation: A girl was admitted to our hospital due to SARS-CoV-2 infection, 3 months before admission the patient received LT due to Niemann-Pick disease (NPD). During hospitalization, blood gas analysis showed severe mixed acidosis. To relieve mixed acidosis, the patient was given oral rehydration salt and liquid replacement therapy. Considering that immunosuppressants may cause metabolic acidosis, dose of CsA was decreased and MMF was discontinued.

Results: However, liquid replacement therapy and decreased CsA dose cannot improve the condition. As an attempt, MMF was discontinued, and 3 days later, the girl's acidosis was relieved, the latest blood gas analysis was normal with the original dose of CsA and no use of MMF or other IS. In addition, we used Naranjo Scale to see if adverse drug reactions (ADRs) existed. The final score was 6 which means MMF contributes to acidosis probably.

Conclusion: The girl's mixed acidosis cannot be explained by Niemann-Pick disease and SARS-CoV-2 infection. CNIs could cause metabolic acidosis but declining the dose of CsA didn't improve her acidosis while withdrawing MMF showed a good effect. Together with the Naranjo Scale result, we suspect that acidosis maybe a rare side effect of MMF.

Keywords: COVID-19; immunosuppressants; liver transplant; mixed acidosis; mycophenolate mofetil.

Publication types

Case Reports