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Kidney transplant survival in the shadow of dengue fever: A case series with favorable outcomes
*Corresponding author: Fakhriya Juma Alalawi, Department of Nephrology, Dubai Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates. fjalalawi08@yahoo.co.uk
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Received: ,
Accepted: ,
How to cite this article: Alnour HH, Alalawi FJ, Ockba EA, Mohamed ME, Alhadari AK. Kidney transplant survival in the shadow of dengue fever: A case series with favourable outcomes. World Adv Renal Med. 2025;1:40-8. doi: 10.25259/WARM_4_2025
Abstract
Dengue fever has seen a concerning rise globally, with a particularly sharp increase in cases across the Middle East. Despite the growing prevalence, there remains a significant gap in understanding the renal implications of dengue fever in renal transplant recipients. This study aims to provide valuable insights into the renal impact of dengue in this vulnerable population. We conducted a retrospective case series involving adult renal transplant recipients diagnosed with dengue fever at Dubai Hospital, UAE, in 2024. The study included 5 patients with a median age of 37 years, 60% of whom were male. Clinical data, including renal function and disease progression, were carefully analyzed during their hospital stay. Among the five patients, two developed dengue fever with warning signs as defined by the World Health Organization severity criteria. Notably, 60% of patients exhibited acute transient allograft dysfunction, as classified by the KDIGO acute kidney injury guidelines. However, despite these challenges, all patients showed complete recovery of their renal function, with serum creatinine levels returning to baseline by the time of discharge. Our findings demonstrate that dengue fever, while concerning renal transplant recipients, generally leads to a favorable outcome, and results were comparable to dengue fever patients in the general population. Early diagnosis, prompt supportive care, and close monitoring in the initial stages of infection are essential in mitigating the risk of progression to severe dengue and ensuring a positive clinical outcome.
Keywords
Acute kidney injury (AKI)
Dengue fever
Dengue virus
Kidney transplant
Thrombocytopenia
INTRODUCTION
Dengue is a mosquito-borne viral infection (arboviral) transmitted by Aedes Aegypti and less frequently by Aedes albopictus mosquitoes.[1] It is the most rapidly expanding arboviral infection worldwide, with approximately 390 million infections occurring annually, based on the World Health Organization (WHO) estimation.[2] It is endemic in the Southeast Asia Region, the Western Pacific Region, the Caribbean, and Central and South Americas.[3] Four serotypes of dengue virus exist (DENV-1, DENV-2, DENV-3, and DENV-4). Each serotype has unique characteristics and can lead to varying disease severity. Any serotype infection does not reduce the likelihood of contracting another serotype. In fact, a serotype infection may increase the risk of contracting a different serotype, potentially leading to severe dengue or shock.[4,5]
Dengue infection is often asymptomatic. However, symptoms can range from mild febrile illness to severe complications, including shock, multiple organ involvement, and severe bleeding.[2,5] Renal manifestations of dengue may include proteinuria, hematuria without thrombocytopenia, rhabdomyolysis, and acute kidney injury (AKI).[6] Kidney transplant recipients are at a heightened risk due to their compromised immune systems, which can lead to atypical presentations, graft dysfunction, and severe disease progression.[5,7] Despite relatively limited information on dengue viral infection’s impact on kidney allograft recipients, all published reports of dengue infection in renal transplant patients have reported favorable outcomes in the majority of cases.[6,8]
Here, we present five kidney transplant recipients infected with dengue fever to highlight the impact and study the outcome of dengue fever among kidney transplant recipients in our area.
CASE SERIES
Case 1
A 22-year-old Iranian male underwent a second deceased donor kidney transplant in 2022, maintained on triple immunosuppressive therapy (tacrolimus, mycophenolic acid, and prednisolone). He was presented on June 24 with a fever for 1-day duration and a dry cough for 2 days. His review of systems was negative otherwise. On presentation, he had a high-grade fever and was tachycardic, and clinical examination was unremarkable. Laboratories on presentation were significant for raised creatinine of 2.05 mg/dL from a baseline of 1.74 mg/dL and C-reactive protein (CRP) 73.3 mg/L. Platelet count has gradually reduced, reaching 114 × 109/L (from a baseline of 250–374 × 109/L). He was found to have dengue Ns1 Ag positive. He was admitted for 3 days and was managed conservatively with fluids and antipyretics, without antibiotics. Mycophenolate mofetil (MMF) was kept on hold while inpatient and was resumed later. His creatinine returned to baseline upon discharge while septic markers were trending down.
Case 2
A 23-year-old Pakistani female with a live-related donor renal transplant (her mother) in 2021. She is on triple immunosuppressive therapy (tacrolimus, mycophenolic acid, and prednisolone). She had recurrent urinary tract infections (UTIs) in the past and was kept on nitrofurantoin prophylaxis. She presented on June 24 with a few days’ history of fever, nausea, body aches, and weakness. On presentation, she had a low-grade fever and was tachycardic, and the rest of the clinical examinations were unremarkable. She was found to have dengue Ns1 Ag and immunoglobulin G (IgG) positive, with raised inflammatory markers.
Urinalysis showed leukocyte esterase 3+ with numerous white blood cells (WBCs). Her urine culture showed mixed growth, probably contamination. Other laboratories on presentation were unremarkable. She was admitted for 4 days and received supportive care in addition to IV antibiotics that were started empirically for possible urinary infection. During her admission, her serum creatinine was raised to 1.31 mg/dL from a baseline of 1.1 mg/dL and returned to baseline on discharge. However, her platelets have mildly reduced, reaching 177 × 109/L during admission (from baseline 305–360 × 109/L).
Case 3
A 37-year-old male from Sierra Leone presented with a history of hypertension and a deceased donor renal transplant recipient for 2022. He is on triple immunosuppressive therapy (tacrolimus, mycophenolic acid, and prednisolone). He presented on June 24 with a 2-day history of fever with headaches. Upon presentation, he was vitally stable, and clinical examinations were unremarkable. His basic laboratory showed a platelet count of 73 × 109/L. He was found to have dengue NS1 Ag positive. He was admitted for 10 days, received supportive management, and continued on immunosuppressive treatment, except for Myfortic, which was stopped temporarily. His WBC count gradually declined, reaching 1.4 × 109/L on day 5 of admission, then slowly improved to 2.3 × 109/L upon discharge and normalized on follow-up later. In addition, his platelet count had dropped further to a maximum of 24 × 109/L during hospitalization, followed by gradual improvement to 85 × 109/L. Peripheral blood film confirms bi-cytopenia (leukopenia and thrombocytopenia), with many large platelets. Cytomegalovirus (CMV)-polymerase chain reaction (PCR) was negative, with negative blood and urine culture. His creatinine reached a peak of 2.2 mg/dL during his hospital stay and returned to his baseline of 1.77 mg/dL upon discharge. His sodium had dropped to 117, which was corrected slowly with hypertonic saline. Despite his severely deranged laboratories, he remained clinically stable with no active bleeding.
Case 4
A 56-year-old Syrian male with a kidney transplant recipient from a live-related donor (cousin) since 2007, on triple immunosuppressive therapy: cyclosporine mycophenolate and prednisolone. He presented on May 24 with high-grade fever, sore throat, and generalized body aches of 2-day duration. On presentation, he was having a high-grade fever and tachycardia. The rest of the clinical examinations were unremarkable. His laboratory results on presentation showed a platelet count of 133 × 103/uL. He had raised inflammatory markers with CRP of 105 mg/L and procalcitonin of 0.29 ng/mL. He tested positive for dengue fever virus RNAPCR test (ribonucleic acid polymerase chain reaction test). He was admitted for 8 days and started on supportive management. His platelet count initially declined, reaching a nadir of 52 × 109/L, then improved gradually, returning to the normal range. His WBC reduced gradually from 4.9 to 2.7 × 109/L and then returned to normal on discharge. He received empirical antibiotics for his fever, together with hydration and supportive therapy. Mycophenolate was held as an inpatient. His Creatinine remained within the normal range during hospitalization and on discharge.
Case 5
A 59-year-old Filipino lady presented with a history of type 2 diabetes mellitus, hypertension, hypothyroidism, and deceased donor renal transplant recipient since January 2024 with frequent post-transplant admissions for recurrent UTI. She is on triple immunosuppressive therapy (tacrolimus, mycophenolic acid, and prednisolone). She presented on July 24 with a 2-day history of fever with chills. On presentation, she had a high-grade fever of 38.6 with tachycardia of 109 b/min. Clinical examinations otherwise were unremarkable. Laboratories on presentation were significant for raised creatinine of 1.53 mg/dL from a baseline of 1.04 to 1.09 mg/dL. She had raised inflammatory markers (C-reactive protein [CRP] 113 mg/L, procalcitonin (PCT) 0.49 NG/mL). She was found to have a positive dengue serology IgG and immunoglobulin M (IgM). In addition, her urine had grown (Extended-spectrum beta-lactamases [ESBL] positive) Escherichia coli, for which she received ertapenem. She received supportive care for her dengue infection, and Myfortic was held temporarily in the sitting of active infection. Her platelet count remained normal all through. Her creatinine gradually returned to baseline of 1.13 mg/d, upon discharge.
All 5 patients’ demographic data and their labs are displayed in Table 1.
| Patients characteristics | |||||
|---|---|---|---|---|---|
| Case number | P1 | P2 | P3 | P4 | P5 |
| Age in years | 22 | 23 | 37 | 57 | 59 |
| Gender | Male | Female | Male | Male | Female |
| Donor | Deceased | Live | Deceased | Deceased | Live |
| Transplant in years | 4 years | 3 years | 2 years | 17 years | 0.6 years |
| Hospital duration in days | 3 days | 4 days | 10 days | 8 days | 9 days |
| Symptoms | Fever, dry cough, | Fever, nausea, body ache | Fever, headache | Fever, chills | Fever, sore throat, body ache |
| Dengue severity as per WHO 2009 classification | Dengue without warning signs | Dengue without warning signs | Dengue with warning signs | Dengue with warning signs | Dengue without warning signs |
| Median time from onset of symptoms to diagnosis | 3 days | 4 days | 2 days | 2 days | 2 days |
| Comorbidities | None | None | Hypertension | Diabetes mellitus, Hypertension, Hypothyroidism | None |
| Laboratories | |||||
| Hemoglobin (maximum) | 15.1 | 13.4 | 16.4 | 13.7 | 11.9 |
| HCT (40.0–50.0%), maximum | 47% | 39.50% | 50.90% | 41.20% | 35.20% |
| WBC (109/L) | |||||
| On presentation | 7.7 | 5 | 4.6 | 4.9 | 12.2 |
| Leukopenia during hospitalization | Not present | 3.4 | 1.4 | 2.7 | Not present |
| Platelets (109/L) | |||||
| On presentation | 197 | 254 | 73 | 133 | 235 |
| Maximum drop | 114 | 117 | 24 | 52 | No drop |
| On discharge | 114 | 117 | 189 | 165 | 429 |
| Rate of drop | 42% | 53.90% | 16% | 67.10% | No drop |
| CPK | Not done | ||||
| Creatinine in mg/dL | |||||
| On presentation | 2.05 | 1.23 | 1.88 | 1.33 | 1.53 |
| Highest creatinine | 2.05 | 1.31 | 2.2 | 1.43 | 1.53 |
| On discharge | 1.78 | 0.93 | 1.77 | 1.2 | 1.13 |
| Sodium level in mmol/L (lowest) | 132 | 135 | 117 | 132 | 131 |
| KDIGO AKI staging | Stage 1 | Stage 1 | Stage 1 | No AKI | No AKI |
| Antibiotic received | none | Levofloxacin | none | Ceftriaxone | Ciprofloxacin |
| Antiviral | None given to any patient | ||||
WHO: World Health Organization, WBC: White blood cell, AKI: Acute kidney injury, HCT: Hematocrit, CPK: Creatinine phosphokinase, KDIGO: Kidney disease improving global outcomes.
DISCUSSION
In April 2024, the UAE experienced its heaviest recorded rainfall, causing significant flooding in some areas and allowing mosquitoes to breed and spread dengue infections. Consequently, the country has witnessed a sudden increase in dengue cases from April to July 2024. The Department of Health reported on April 25 that there have been locally transmitted cases without a travel history, attributed to “climate change and an environment conducive to mosquito breeding.”[9,10]
Accordingly, in 2024, our institution reported five cases of dengue fever among kidney transplant recipients. All five patients achieved favorable outcomes, with no patients developing acute allograft rejection or allograft loss, no patients requiring dialysis, and a zero percent mortality rate. The mean period of hospitalization was 6.8 days (3–10 days), while the median time from the onset of symptoms to diagnosis was 2.6 days.
The majority of published dengue cases in renal transplant recipients had similar outcomes to those reported in the normal population;[5,8,11] though, some reported severe dengue with impaired graft function.[12,13] In kidney transplant recipients with dengue fever, symptoms are often concealed due to immunosuppression, leading to atypical presentation and making diagnosis challenging.[8] Common symptoms include high fever, severe headaches, retro-orbital pain, malaise, nausea/vomiting, abdominal pain, myalgia, arthralgia, and rash.[8,13] Bleeding manifestations such as petechiae, epistaxis, gum bleeding, hematemesis, melena, and hemoglobinuria can occur, which assist in identifying early suspected cases of dengue.[8,13] The most common presenting symptom in our patients was fever at 100%, followed by generalized body aches at 40%. Nevertheless, dengue fever symptoms can also be linked to a possibly coexisting opportunistic infection, other co-morbid medical conditions, or adverse effects of immunosuppression, subsequently complicating the clinical picture and leading to a delay in timely diagnosis and management.[14-16] Diagnosing dengue in these patients requires a high index of suspicion. Thus, any transplant recipient presented with fever and/or viral-like illness associated with cytopenia (leuko- or thrombocytopenia) should prompt the consideration of dengue in the differential diagnosis.[17] Diagnosis of dengue fever may involve serological tests (such as NS1 antigen detection, IgM/IgG antibody testing, and reverse transcription-PCR assays) to confirm the presence of the virus and perform a swift diagnosis.[4,18] The 2009 WHO criteria classify dengue according to the level of severity: dengue without warning signs, dengue with warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing hematocrit, and dropping platelets), and severe dengue (dengue with severe plasma leakage, severe bleeding, or organs failure).[19] In terms of this WHO-2009 dengue criteria classification, 40% of our patients had dengue with warning signs, including a rapid and severe decline in platelets count to <100 × 109/L, which normalized upon discharge, though others also had a mild reduction in platelets count [Table 1]. 60% developed leukopenia with the lowest value of 1.4 × 109/L. No increase in hematocrit was noted, as described in the general population, and none of our patients developed significant liver function abnormalities.
The outcomes of dengue fever in kidney transplant recipients vary in different literature, probably reflecting various geographical areas, where a complex interaction between different genetics of viral serotypes and population-specific immunity contributes to the risk of severe dengue disease.[12,20] In general, the majority of published reports reported favorable outcomes among kidney recipients, though some reported severe cases with a higher rate of complications such as AKI, hemorrhagic manifestations, prolonged hospitalization, and fatality compared to non-transplant patients.[7,8,12,13,17,21,22] Table 2[23-34] summarizes almost all published reports on dengue fever among kidney transplant recipients to date.
| Author name | Type of study/and center location | Year of publication | Presentation | Outcomes | Management |
|---|---|---|---|---|---|
| Azevedo et al.[23] | Cross-sectional of 27 patients/Brazil | 2007 | Fever (100%), muscular pain (90%), malaise (75%), and headache (68%). 1 patient out of 27 (1/27) had DHF. |
One death. Other cases had a full recovery. All AKI returned to baseline after recovery. |
Not mentioned. |
| Renaud et al.[16] | Retrospective study of six cases. Singapore |
2007 | Thrombocytopenia, leucopenia. Hepatitis (in 2 cases) | No dengue hemorrhagic fever, DSS, deaths, or abnormal graft function were observed. | Not mentioned. |
| Park et al.[24] | Single patient case report/South Korea | 2008 | Acute colitis. Leukopenia, thrombocytopenia, and elevated serum transaminase levels. | Full recovery | Intensive supportive care while continuing on tacrolimus as monotherapy. |
| Prasad et al.[12] | Case series of 10 patients/India | 2012 | All patients had fever, myalgia, retro-orbital pain, and thrombocytopenia. | 3 out of 8 patients developed dengue hemorrhagic shock syndrome and died. 4/8 had graft dysfunction, 1 recovered, and 3 died. |
Not mentioned. |
| Tangnararatchakit et al.[25] | Single case report/Thailand | 2012 | Severe non-febrile dengue infection complicated with refractory pancytopenia, refractory anemia and a large perinephric hematoma with hypovolemic shock and acute graft failure. | Full recovery | Supportive care |
| Nasim et al.[21] | Cross-section analysis of 102 patients/Pakistan | 2013 | Fever in 82 (80.4%), gastrointestinal symptoms in 35 (34.3%), hemorrhagic complications in 9 (8.8%), and thrombocytopenia in 97 (95%). DHF/DSS occurred in 12 (11.7%). | Of 102 KTR, 68 (66.7%) had graft dysfunction, 5 of whom died. Of the remaining 63, in 54 patients (85.7%), creatinine returned to baseline. Of 102 patients, 95 (93%) recovered and 7 (6.9%) died secondary to concomitant sepsis. |
Supportive care |
| Costa et al.[26] | Single-center, retrospective Case series of 10 KTRs/Brazil. | 2015 | 4/10 patients developed DHF. All patients had myalgia and headache. 9/10 had fever. | No patient died. | |
| Maia et al.[27] | Case series of 2 patients/Brazil | 2015 | Abdominal pain and ascites. The second patient had a fever, AKI with decreased diuresis, abdominal pain, and pancytopenia. |
Both patients had complicated courses. 1 died of severe hemorrhagic shock, while the other survived. | Supportive therapy, including blood and platelet transfusion. |
| Kenwar et al. (Poster)[28] | A case series of 32 patients tested dengue-positive on screening. 4/32 were at<3 months post-transplants/India | 2018 | Fever, myalgia in all 100%, and diarrhea in 5 patients (15.2%). Leukopenia in 34%, and Thrombocytopenia in 81%. Graft dysfunction in 12/32 patients (37.5%). |
One out of four patients with early transplant period dengue expired due to DSS with renal failure, 1 had persistent renal dysfunction, and 2 had adequate recovery of renal function. For those with late-period dengue, 1 expired due to DSS. | Supportive management including platelets transfusion and G-CSF administration. Adjustment of immunosuppression |
| Weerakkody et al.[13] | Case report of 1 patient with chronic hepatitis B infection. Sri Lanka |
2018 | Acute renal failure requires dialysis, Upper gastrointestinal bleeding, and Pancytopenia with prolonged thrombocytopenia. | Fully recovered renal functions. | Supportive management, including blood transfusions and antibiotics. Temporary cessation of Tenofovir and Azathioprine. |
| Subbiah et al.[29] | Retrospective analysis of 20 KTRs. Brazil |
2018 | Two patients had severe dengue (DHF, DSS). Fever in 95%, myalgia (65%), headache (30%), retro-orbital pain (10%), and mucocutaneous bleeding manifestations (10%). 90% had thrombocytopenia, and Leucopenia in 50%. About 60% had transient transaminitis. About 40% of patients had graft dysfunction. | One patient with severe dengue expired, and 1 recovered with IV immunoglobulin therapy. AKI recovered in all surviving patients. | Supportive management including platelets transfusion Adjustment of immunosuppression |
| Rosso et al.[11] | Case series of 20 patients/Colombia | 2019 | - 75% of patients had at least one warning sign, - 45% was managed in the intensive care unit, - 30% had severe dengue. |
-Full recovery -No graft rejection |
- Supportive management - None of the patients required a blood transfusion. |
| Fernandes- Charpiot et al.[7] | Retrospective Cohort study of 39 patients/Brazil. | 2019 | Fever, myalgia, malaise, and headache, with leucopenia, thrombocytopenia, and elevated liver enzyme. -19% of patients had CMV coinfection, aggravating their clinical presentations. |
59% had acute graft dysfunction, and 4 patients required dialysis. After 30 days: 69% had full recovery of renal function. 3 patients lost their grafts, and 1 patient required long-term dialysis. - Two patients died |
Supportive therapy with adjustment of immunosuppressive therapy. |
| Pinsai et al.[5] | Retrospective analysis of 13 patients over 20 years/Thailand. | 2019 | Fever (100%), Myalgia (69%), Headache (39%), Bleeding (23%), Diarrhea (23%), Arthralgia (8%) and pleural effusion (8%) | - No mortality - Most cases were completely resolved without complications - 1 patient had hemophagocytic lymphohistiocytosis - One patient had allograft failure. |
Supportive management Adjustment of immunosuppression |
| Thomas et al.[30] | An observational study included 12 renal transplant recipients, 22 patients with Chronic kidney disease (CKD), and 58 patients with normal renal function. India |
2019 | 11/12 renal transplant had AKI. 1/11 required dialysis. Leukopenia was prevalent in transplant recipients. |
AKI among renal transplant recipients was less severe and transient. | Supportive care |
| Patel et al.[31] | A prospective observational study included 31 patients. India |
2020 | 20 of the 31 cases developed AKI. | - 100% survival rate. - One graft loss in a patient with concomitant CMV. |
- Supportive management. |
| Meshram et al.[32] | Retrospective cohort study of 59 patients. India |
2021 | The most common symptoms were Fever (93%), Chills (68%), Headache (48%) and Retro-orbital pain (29%). The most common clinical signs were conjunctival redness (25%), Hepatomegaly (25%) and Oliguria (22%). |
- No mortality - Allograft dysfunction in 64.5%, Acute rejection in 6.4%, and Graft losses in 6.4% - One patient required ICU admission - No rejection or graft losses in 1-year follow-up. |
- Supportive management, including blood transfusion, granulocyte colony-stimulating factor for severe leukopenia and hemodialysis. - Immunosuppression modification. |
| Bansal et al.[33] | Retrospective Case series of 23 KTR patients. 4 of 23, were diagnosed with DENV in their early postoperative period/India | 2022 | All patients had fever along with thrombocytopenia, as their initial symptom | 1 required intensive care. 2 had AKI, which recovered after the resolution of the infection. | - Supportive management including platelets transfusion and G-CSF administration. - Adjustment of immunosuppression (antimetabolite withhold) |
| Ribeiro et al.[34] | Case series of 19 patients. Brazil. |
2022 | Myalgia, headache/retro-orbital pain, fever, Thrombocytopenia, and gastrointestinal symptoms. 3 had pleural and/or pericardial effusion and 1 developed acute myocarditis. -AKI in 58% of patients. |
-Full recovery - No mortality or kidney graft loss. |
- Supportive management - Reduction of immuno-suppressive treatment. |
| Tan et al.[22] | Retrospective analysis of 31 patients over 15 years. Singapore |
2024 | - Fever (87.1%), - Myalgia (41.9%), - Gastrointestinal symptoms (38.7%) and headache (25.8%). - 29.0% had dengue with warning signs and 3 (9.7%) had severe dengue. |
- 17 (54.8%) patients had graft dysfunction, 16 of whom had recovered graft function. One patient required dialysis and subsequently died. | Supportive management Adjustment of immunosuppression (antimetabolite stopped or reduced) |
KTR: Kidney transplant recipients, DHF: Dengue hemorrhagic fever, DSS: Dengue shock syndrome, ICU: Intensive care unit, AKI: Acute kidney injury, DENV: Dengue virus, G-CSF: Granulocyte colony-stimulating factor, CKD: Chronic kidney disease.
The risk of graft dysfunction is a significant concern in dengue fever.[35] As per the KDIGO-AKI classification, 60% of our patients developed stage-1 AKI. Similarly, Nasim et al.,[21] reported graft dysfunction in 66.7%, while Ribeiro et al.[34] and Costa et al.[26] reported AKI in 58% and 80%, respectively, of their cases. Like us, all their patients had returned to pre-DENV kidney function levels within two weeks. A systematic review of the literature on DENV infection in kidney transplant recipients reported graft dysfunction in almost 60% of the cases.[8] Subbiah et al. and Farrar et al.[29,36] suggested that renal dysfunction can be caused by febrile disease, dehydration/hypovolemia caused by capillary leakage, vomiting, bleeding, and other infection-related factors rather than a direct viral cytopathic effect. In some cases, the need for dialysis may arise. Fortunately, our patients did not encounter any, possibly because they presented early in their illness course.
Managing dengue fever in kidney transplant recipients is mainly supportive, with close monitoring of vital signs, fluid balance, and laboratory parameters. Supportive care, including hydration and pain management, is crucial for managing symptoms.[37] All five patients were on triple immune suppressants; tacrolimus, steroids, and antimetabolite therapy (Mycophenolate/Myofortic). For all five patients, tacrolimus and steroids were continued with some dose adjustments for some patients, while Mycophenolate/Mycophenolic acid was kept on hold during hospitalization. There is no standardized approach to managing immunocompromised patients with dengue fever in terms of reducing immunosuppression, and no specific protocol has been established. Meshram et al.[32] reported successful recovery in 59 patients, including those with severe dengue requiring intensive care unit admissions and dialysis, using supportive care and stopping antimetabolite therapy for all dengue cases, while holding calcineurin inhibitors for only dengue cases with warning signs. Overall, physicians may need to adjust immunosuppressive therapy during the acute phase of dengue to reduce the risk of severe disease while balancing the risk of graft rejection.
CONCLUSION
There are limited case series concerning the impact of dengue fever in renal transplants. This is the first case series done in the United Arab Emirates addressing this subject. Our study demonstrated a favorable outcome of dengue fever in renal transplant recipients, and results are comparable to dengue fever patients in the general population.
Author contributions:
All authors contributed equally to the development of this case series. Each author participated in the conception and design of the study, the acquisition and interpretation of clinical data, the drafting and critical revision of the manuscript, and the approval of the final version.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
Patient’s consent is not required as patients identity is not disclosed or compromised.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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