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Despite a decreased incidence and severity of acute rejections in 1998, compared with the previous years, acute rejection still remains a powerful risk factor for late transplant failure.

Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have cardioprotective and renoprotective effects. However, experience with SGLT2i in diabetic kidney transplant recipients (DKT) is limited. Methods This observational multicentre study was designed to examine the efficacy and safety of SGLT2i in DKTR. The primary outcome was adverse effects within 6 months of SGLT2i treatment. Results Among 339 treated DKTR, adverse effects were recorded in 26%, the most frequent being urinary tract infection (UTI) (14%). In 10%, SGLT2i were suspended mostly because of UTI. Risk factors for developing UTI were a prior episode of UTI in the 6 months leading up to SGLT2i onset [OR 7.90 (CI 3.63–17.21)] and female sex [OR 2.46 (CI 1.19–5.03)]. In a post-hoc subgroup analysis, the incidence of UTI emerged as similar in diabetic kidney transplant recipients treated with SGLT2i for 12 months than non-diabetic kidney transplant recipients (17.9% vs 16.7%). Between baseline and 6-month, significant reductions were observed in body weight [─2.22 (─2.79, ─1.65) kg], blood pressure, fasting-glycemia, HbA1c [─0.36 (─0.51, ─0.21) %], serum uric acid [─0.44 (─0.60, ─0.28) mg/dl] and urinary protein/creatinine ratio, while serum magnesium [+0.15 (0.18, 0.11) mg/dl] and hemoglobin levels rose [+0.44 (0.28–0.58]. These outcomes persisted in participants followed over 12 months of treatment. Conclusions SGLT2i in KT offers benefits in terms of controlling glycemia, weight, blood pressure, anemia, proteinuria, and serum uric acid and magnesium. UTI was the most frequent adverse effect. According to our findings, these agents should be prescribed with caution in female DKTR and those with a history of UTI.

Imiquimod is an immunomodulator of the imidazoquinoline group which possesses antiviral and antitumour activities. Although its mechanism of action has not been entirely elucidated yet, imiquimod 5% cream has been shown to be an efficient, long-lasting and safe therapy for multiple actinic keratoses in non-immunosuppressed patients and in transplant recipients. We report the case of a 44-year-old patient with a third renal transplant who developed an acute tubular necrosis confirmed by renal biopsy after the use of imiquimod 5% cream. The result of a literature search revealed a wide variety of side effects attributable to the use of imiquimod.

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