Immunomodulators, including dexamethasone (DEX), have been recommended by the Infectious Disease Society of America (IDSA) to treat moderate, severe, and critical COVID-19. Tocilizumab (TCZ) was added to the treatment recommendations based on recent data from two large randomized controlled trials and its potential synergistic effect with DEX. We included adult patients admitted from June until October 2020 with a PCR confirmed SARS-CoV-2 infection. 135 patients with severe to critical COVID-19 and received TCZ and/or corticosteroid or DEX were retrospectively evaluated and followed until hospital discharge or death. The cohort was divided into two different groups of patients; TCZ group received TCZ ± corticosteroid, N = 100 and DEX group received DEX, N = 35. Groups were analyzed for hospital mortality. The rate of hospital mortality was 36% in TCZ and 37% in the DEX group, p = 0.91. Age of 60 years and above was associated with higher mortality rate with OR = 1.030 and 95% CI = (1.004, 1.057). More than 50% of patients required MV in both groups. Development of bacterial or fungal infection post immunomodulator were similar in TCZ and DEX groups, 29% vs. 31.4%. Our study revealed that age of 60 years and above is the only factor associated with higher mortality rate regardless of the type of immunomodulator therapy. Findings of this study also revealed the lack of synergistic effect between TCZ and DEX on the hospital mortality.

Purpose: Tacrolimus is a calcineurin inhibitor that suppresses immunity by inhibiting T-lymphocyte activation. It has a high intra- and inter-patient variability in its pharmacokinetics. Therefore, therapeutic drug monitoring is required to individualize the dose. High tacrolimus trough level variability is associated with a higher risk of adverse effects. In practice, the initial dosing and sampling time of tacrolimus levels is not standardized, which may result in resource wastage, frequent blood sampling, and a longer time to achieve therapeutic levels. The aim of this study was to evaluate tacrolimus trough level variation and its correlation to clinical outcomes and consequences. Patients and Methods: A retrospective cohort study At King Abdulaziz Medical City in Riyadh, Saudi Arabia, 01/01/2018 to 31/12/2021. Inclusion Criteria: > 18 years old solid organ transplant patients who received tacrolimus as part of their initial immunosuppression regimen. Tacrolimus initial dosing, trough levels, and dose adjustments were recorded during the early post-transplantation period (first 10 days). The coefficients of variation (CV%) in tacrolimus doses and trough concentrations were calculated and compared for different demographics and clinical characteristics. Results: The higher coefficient of variation in dose and trough level is associated with different demographic and clinical factors that will predict the incidence of adverse events. In our study, there was a significant increase in adverse effect reporting in the high variability group but was not clear for the risk of graft function, acute rejection, or infections. Conclusion: The variation in trough levels is associated with clinical consequences. Therefore, better dosing strategies can be modified to reduce the variation (fluctuation) which is associated with poor outcomes.

BACKGROUND Herbal medicine is commonly used in Saudi Arabia, and is widely viewed as natural and safe. However, its use among transplant recipients poses risks due to interactions with immunosuppressive therapies. This study explores herbal medicine use, knowledge, and attitudes among Saudi transplant recipients. MATERIAL AND METHODS A cross-sectional study of 203 transplant recipients from multiple clinics in Saudi Arabia was conducted using a structured questionnaire to assess demographics, herbal supplement use, awareness of risks, and attitudes. Statistical analyses compared users and non-users of herbal supplements. RESULTS Post-transplant herbal supplement use decreased significantly (44.3% to 19.2%, p=0.0001). Many relied on unreliable sources like friends or the internet, and 54.24% of reported supplements posed interaction risks with immunosuppressive drugs. Participants aware of these risks were significantly less likely to use herbal supplements (15% vs 88%, p=0.0007). Alarmingly, 81.1% received no pre-transplant education, and 70.4% received no post-transplant care, despite 81% desiring guidance from healthcare providers. CONCLUSIONS Herbal supplement use among transplant recipients in Saudi Arabia is prevalent and risky due to potential drug interactions. Most patients lack education about these risks, underscoring the need for improved healthcare education.

Background: Kidney transplantation improves life expectancy in patients with end-stage renal disease but encounters ethical concerns, particularly in commercial transplantation, which yields worse outcomes. Anti-thymocyte globulin (ATG) is an immunosuppressant used as an induction therapy in transplantation. This study evaluates ATG induction therapeutic outcomes in commercial kidney transplants. Methods: A retrospective cohort analysis was conducted on adults who underwent commercial kidney transplantation and were subsequently admitted to King Abdulaziz Medical City spanning 2018 to 2023, with a follow-up period of one year. Results: A total of 70 commercial kidney transplant patients were evaluated by comparing patients who received ATG (n = 24) and those who did not (n = 46). ATG patients had elevated serum creatinine levels at admission (mean 457.5 vs. 172.6 µmol/L, p < 0.001). Over time, creatinine levels in the ATG group improved but remained higher than the non-ATG group (p < 0.001). Despite the higher early rejection rate in the ATG group, this difference was not statistically significant (p-value = 0.256). Elevated admission creatinine strongly predicted rejection (OR = 10.08, p < 0.001). Conclusions: Elevated admission creatinine is a significant predictor of rejection. Although the ATG group showed a higher early rejection rate, this difference was not statistically significant. Early rejection remains a concern, particularly within the first month after transplantation.