Abstract: SA-PO1169
Balancing Rejection and Infection Risk: A Case of Disseminated Mpox in an HIV-Positive Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Huda, Hammad Ibrahim, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
- Mehta, Pooja, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
- Sahni, Tamanna, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
- Li, Ping, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
Introduction
Kidney transplantation in HIV-positive patients has been performed for the past 2-3 decades with excellent graft survival. However, these patients are at significantly higher risk of rejection. When using intensified immunosuppression, one must also consider the risk of opportunistic infections. This case presents the challenge of immunosuppression in a rare opportunistic infection with the mpox virus in an HIV-positive transplant recipient.
Case Description
A 45-year-old man with well-controlled HIV underwent deceased donor kidney transplantion with thymoglobulin induction. Maintenance immunosuppression included tacrolimus, mycophenolate mofetil, and prednisone. Over 1 year post transplant, he presented with a diffuse vesiculopustular rash, with PCR-positive lesions for mpox.
In terms of immunosuppression, the mycophenolate (720mg AM / 360mg PM) was held and prednisone was increased from 5mg to 10mg daily. The tacrolimus goal was kept at 5-7 ng/ml. The patient was treated with tecovirimat and brincidofovir for 2 weeks with resolution of the lesions. Mycopheonlate was subsequently restarted at the same dose and prednisone was reduced back to 5mg. Fortunately, renal function remained stable and serum creatinine was 1.36 mg/dl at 6 months follow up.
Discussion
HIV-positive kidney transplant recipients are at higher risk for opportunistic infections given their dual immunocompromised status and are also at higher risk for acute rejection. Severe mpox is rarely reported in kidney transplant patients and can be associated with significant morbidity in the setting of immunosuppression. This case highlights the lack of standardized immunosuppression adjustment in mpox among kidney transplant recipients with HIV. Temporarily holding the antimetabolite is a safe treatment option. Reducing the tacrolimus goal and increasing steroid dose can also help balance rejection and infection risk.
Figure 1. Disseminated facial mpox lesions