New-Onset Antibiotic Anaphylaxis Post Kidney Transplant: A Role of Calcineurin Inhibitors?
Bibliographic record
Abstract
Introduction: Calcineurin inhibitors (CNIs), such as tacrolimus and cyclosporin, are a mainstay of post-transplant immunosuppression. Immunosuppressive medications typically suppress type I allergic reactions, however, there have been reports of allergic sensitization post-transplantation, despite no known drug allergies. Case Description: We report two cases of antibiotic-related anaphylaxis post kidney transplant. In case one, a 63-year-old male was admitted for an elective transurethral prostate resection having received an NDD renal allograft two-months prior and maintained on tacrolimus, mycophenolate and prednisone. Preoperatively, cefazolin was given for antibiotic prophylaxis, but he developed an anaphylactic reaction leading to hemodynamic collapse requiring ICU admission. Serum tryptase (37.6ug/L, normal <11.4ug/L) and histamine (20.4ng/mL, normal <1ng/mL) levels were markedly elevated confirming anaphylaxis. In case two, a 56-year-old male received a DCD renal allograft (on immunosuppression with prednisone, mycophenolate and tacrolimus), eleven months prior to admission for suspected sepsis. He was empirically treated with ceftazidime and vancomycin but developed an anaphylactic reaction, requiring intubation and ICU admission. Serum tryptase and histamine levels were not assessed. A comprehensive medication review revealed that both patients had received the offending antibiotics without issues prior to transplantation. In both cases, neither donor had a documented allergy to these medications. Discussion: In these clinical vignettes, we describe two patients with anaphylaxis post transplantation, despite previously tolerating the offending medications without issue. Furthermore, these reactions were not donor derived. Type I allergic reactions are typically suppressed post-transplant, yet there is literature to suggest that allergic sensitization maybe mediated by CNIs. The rates of sensitization are cited to be as high as 10% in liver and kidney recipients. Risk factors for sensitization are not described, although we note both of our patients had anaphylactic events within one-year post transplant. Given the importance of CNIs in allograft immunosuppression balanced against the morbidity of anaphylaxis, these cases highlight the need to better identify high risk patients for such events.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".