Recurring infections post transplant!

Hi @eaa2025 😊
It is nice to meet you! I had my kidney transplant in 2020. I had CMV and BK. Has your husband's immune suppression dosage been reduced? Multiple infections can be an indication that he is over-suppressed and needs a reduction or change in immune suppression. Have the doctors discussed that with you?

Hello,
They have been lowering the dose, his last visit they took him completely off of myfortic, he is currently scheduled to have a WBC scan, so we're hoping they can figure out where the infection is coming from. His wbc count drops when he takes valcyte, so he was taken off of that this last hospital visit as well.

Hi @eaa2025
I am happy to hear that Myfortic was stopped during the last visit to give his body a chance to fight the infection. That will definitely help. Which immune suppression med is he currently taking now?
Regarding the "WBC scan", is your husband scheduled for a Cat Scan?
Why do they think he currently has an infection? Is he having symptoms now that he's back home from the hospital? Or are they seeing an issue with the lab results?

He is prescribed Myfortic, Prednisone and Tacrolimus ER for rejection and Atovaquone, Clotrimazole and Valcyte for infection, with Valcyte and Myfortic on hold currently.
The scan is because of the frequency of infection, particularly Pseudomonas Aeruginosa, this particular infection I believe showed up about 1-2 weeks after they removed the stent post transplant.

Hi @eaa2025
I assume your husband's Tacrolimis is being monitored and kept in the appropriate target range.
When your husband was admitted into the hospital 6 times, was it his transplant center? Was he assigned an Infectious Disease doctor?
Was he transplanted at Mayo or another hospital?

Good morning, yes his tacrolimus levels go up and down but are within range, 5 of the 6 times he was at the transplant center (out of state) however this last time was a local hospital because he was so ill that we couldn't of made it in a timely manner, yes he was assigned a infectious disease dr, according to them they have no clue where the pseudomonas infection is coming from and last visit ordered him a prescription for cipro "just in case" in between visits and that was all. His last visit to the local hospital the infectious disease dr is the one that recommended the wbc scan, that is when I mentioned it to his out of town care team and they set the appointment up for the scan, local infectious disease dr could not run the test due to his wbc and neutrophils being to low at that time, so they gave him a 3 injection series to raise his cells.

Hi @eaa2025
I feel so sorry you are going through all this. When did the pseudomonas infection start?
Are you in consultation with an Infectious Disease doctor at his out of state transplant center about the pseudomonas?

Thank you, Yes we are in contact with infectious disease, actually the care team was supposed to be informing them of the scan that's coming up, I may call them Monday anyway, the pseudomonas started between actual transplant to when the stent was removed approximately 1 week later, they sent it for pathology and it came back positive for pseudomonas and it keeps coming back, I am hopeful for this upcoming test! BK was slightly elevated 1,968 as of yesterday's blood draw

@eaa2025
It looks like currently, your husband is not taking an antibiotic. Does he currently have any remaining symptoms from the pseudomonas, parvo or pneumonia?
Does he take a blood test to confirm positive or negative for the pseudomonas?
The BK viral load is low so that's excellent news.

He's taking two Atovaquone liquid and Clotrimazole tablet to be dissolved under the tongue, blood tests once a week currently but usually bi weekly