Case 10
A 42-year-old male with history of CF (F508del/1716+1G->A) status post a combined liver/kidney transplant in 2003.  His immunosuppression regimen includes tacrolimus and prednisone. He was initiated on full dose elx/tez/iva in early December 2019, with recommended weekly blood work to monitor hepatic panel and tacrolimus troughs.  However, the patient was initially non-compliant with recommended blood work.  Prior to initiation of elx/tez/iva, the patient’s liver function was within normal limits, except for a slightly elevated AST of 46 IU/L. LFTs and a tacrolimus concentration were finally collected in late March 2020, which revealed elevated level of 10.0 ng/mL (goal: 4-6 ng/mL), elevated serum creatinine, and a stable hepatic panel. The tacrolimus dose was subsequently reduced by 50% and repeat a concertation was within goal range at 4.7 ng/mL and serum creatinine returned to baseline. The patient has not complained of any side effects since initiation of elx/tez/iva. The patient’s baseline ppFEV1 was 88%, and after 3 months of therapy with elx/tez/iva, increased to 96%, with corresponding improvement in respiratory symptoms and quality of life.