About

Muna Anwar Alnimri, M.B.B.S., is a Professor in the Department of Internal Medicine at UC Davis Health, specializing in Transplant Nephrology. She earned her medical degree from Jordan University School of Medicine in Amman, Jordan, in 1987. Her postgraduate training includes an internship and residency in Internal Medicine at Unity Health System in Rochester, NY, from 2006 to 2008, and fellowships in Nephrology at Oregon Health Sciences University and Transplant Nephrology at UC San Francisco. Dr. Alnimri is a Fellow of the Royal College of Physicians UK since 2005 and has received the Diamond Doctor Award from UC Davis in 2024. Her clinical interests focus on care for adults with kidney and pancreas transplants, including evaluation for transplantation and living kidney donation. She is involved in research related to clinical trials on immunosuppression medicines, desensitization protocols, follow-up of living donors, and diagnosis of rejection without kidney biopsy. Dr. Alnimri has contributed to numerous publications in her field and believes in fostering direct communication with patients to enhance trust and health outcomes.

Research topics

• Medicine
• Internal medicine
• Radiology
• Gastroenterology
• Pathology
• Library science

Selected publications

• Effect of tacrolimus formulation on neurocognition in older kidney transplant recipients: A randomized controlled trial

  Transplantation Reports · 2025-05-31

  articleOpen access

  • Tacrolimus can cause neurotoxicity, especially in older patients • Tacrolimus comes in immediate-release or slow-release versions • Slow-release tacrolimus did not reduce neurocognitive side effects compared to immediate-release tacrolimus • Effect of early conversion to slow-release tacrolimus may need more than 6 weeks to appear Tacrolimus is known to cause neurotoxicities that may be more severe in older individuals. We aimed to compare the neurocognitive side effects of immediate release (IR) and LCP tacrolimus in older kidney transplant recipients in the early post-transplant period. In this single center, open-label, randomized and controlled trial of 64 kidney transplant recipients aged 60 or above, participants were randomized to LCP tacrolimus or IR tacrolimus between 4- and 8-weeks post-transplantation and followed for 6-weeks. The primary outcome of neurocognitive performance at 6-weeks compared with baseline was assessed by the Montreal Cognitive Assessment (MoCA) and Digit Symbol Substitution Test (DSST). Secondary outcomes included health-related quality of life as measured by the Quality of Life in Essential Tremor Questionnaire (QUEST) and Organ Transplant Symptom and Wellbeing Instrument (OTSWI). 32 patients were randomized to IR tacrolimus and 31 to LCP tacrolimus. In the IR tacrolimus arm, the MOCA score increased by 1.2 points (SD 2.1) and the DSST score increased by 1.0 points (SD 7.8). In the LCP tacrolimus arm, the MOCA score increased by 0.2 points (SD 2.9) and the DSST score increased by 1.3 points (SD 7.5). No statistically significant difference was detected between arms in MOCA, DSST, QUEST or OTSWI scores. There was a trend toward improvement in tremor severity in the LCP tacrolimus arm. No improvement was found in MoCA or DSST performance in patients switched to LCP tacrolimus as compared to IR tacrolimus after 6 weeks of exposure in the early post-transplant period.

  PublisherDOI

• Safety of fluconazole in kidney transplant recipients for prevention of coccidioidomycosis

  Medical Mycology · 2024-02-29

  articleOpen access

  Coccidioides is an endemic fungus that causes infections ranging from mild respiratory illness to life-threatening disease, and immunocompromised hosts such as solid organ transplant recipients are at higher risk for disseminated infection and mortality. Our center administers fluconazole prophylaxis to kidney transplant recipients residing in geographic areas with higher incidences of coccidioidomycosis. However, because drug-drug interactions occur between triazoles and immunosuppressants used in transplant medicine, we undertook a study to ascertain whether fluconazole prophylaxis was associated with any important safety outcomes in kidney transplant recipients. This retrospective study evaluated patients who had undergone kidney transplantation between 2016 and 2019. Data on patient demographics, transplant-related clinical information, use of fluconazole prophylaxis (200 mg daily for 6-12 months post-transplant), and patient outcomes were obtained. The primary outcome was mean estimated glomerular filtration rate (eGFR) at 12 months, comparing those who received fluconazole prophylaxis to those who did not. Secondary outcomes included mean eGFR at 3 months, 6 months, and 9 months post-transplant, patient survival, biopsy-proven graft rejection, graft loss, or a new requirement for post-transplant dialysis, all within 12 months post-transplant. The mean eGFR at 12 months was similar between both groups, with 66.4 ml/min/1.73 m² in the fluconazole prophylaxis group vs. 64.3 ml/min/1.73 m² in the non-fluconazole prophylaxis group (P = 0.55). Secondary outcomes were similar across both groups. Multivariable linear regression found no significant association between fluconazole use and graft function. Fluconazole prophylaxis for prevention of coccidioidomycosis was not associated with adverse graft outcomes in kidney transplant recipients.

  PublisherOA PDFDOI

• Conjunctival Squamous-Cell Carcinoma after Kidney Transplant

  Journal of the American Society of Nephrology · 2024-10-01 · 1 citations

  article1st authorCorresponding

  Introduction: Conjunctival squamous cell cancer (SCC ) is rare affecting HIV patients and elderly exposed to extra UV light, the incidence increases post kidney transplant due to immunosuppression, treatemnt with wide excision,cryotherapy, local chemotherapy and radiation had been successful Prognosis depends on local invasion of the tumor to the orbit and the presence of distal metastasis.Our patient developed SCC 13 years post transplant Case Description: 64 year old Hispanic male farm worker diagnosed with Hypertensive Nephrosclerosis on Hemodialysis received a kidney transplant in 2011 baseline creatinine 1mg/dl was maintained on Tacrolimus 2 mg bid imuran 50 mg as he did not tolerate Mycophenolate Mofetil and prednisone 5 mg . Presented in 2/24 with a right eye mass, tearing and eye discharge, followed by headach (figure 1) Orbital and head MRI showed fungating mass involving the temporal conjunctiva without invasion to the cornea . Biopsy of the lesion showed SCC. He underwent excision/debulking of the mass and pathology confirmed SCC with positive margins, Oncology consult suggested cryotherapy,local chemotherapy or radiation therapy The patient agreed to local chemptherapy with eye drops . Immunosuppression had been reduced with discontinuing imuran and lowering tacrolimus to a level of 3-5 with 5 mg prednisone. Discussion: The risk of SCC increases with the duration of immunosuppression, 7% of transplant patients develop SCC after 10 years and 35% after 25 years ,conjuctival SCC is rare with incidence of 0.02-2.8/100000, It usually grows slowly on the epithelial surface of the eye and rarely invades the orbit and spreads distally, treatment is wide excision of the conjunctive with reconstructive flaps, cryotherapy, topical chemotherapeutic eye drops like mytomycin ,5FU and interferon, prognosis is not bad if dicovered early,5 years survival 85%.

  PublisherDOI

• Maribavir use in patients with renal impairment

  Transplant Infectious Disease · 2023 · 5 citations

  Senior authorCorresponding
  • Medicine
  • Internal medicine
  • Library science

  AK has nothing to disclose. NN has nothing to disclose. MA has nothing to disclose. Data from Takeda Pharmaceuticals U.S.A. Inc. was provided by the company upon specific request from the authors for data on maribavir and renal impairment. Takeda Pharmaceuticals U.S.A. Inc. was not involved in any aspects of manuscript conception or preparation. The data that supports the findings of this paper is available from the corresponding author, AK, upon reasonable request.

  PublisherOA PDFDOI

• Effect of Prolonged-Release vs. Immediate-Release Tacrolimus on Neurocognition in Kidney Transplant Recipients: A Pilot Randomized Controlled Trial (RCT)

  Journal of the American Society of Nephrology · 2023-11-01

  article

  Gul, Hadia Lala; Sockolov, Macey; Kaur, Amanpreet; Occhipinti, Michelle; Bang, Heejung; Alnimri, Muna; Huang, Yihung; Chen, Ling-Xin; Howes, Katherine A. Author Information

  PublisherDOI

• Donor-Derived Fibrillary Glomerulonephritis in a Renal Allograft

  Journal of the American Society of Nephrology · 2021-10-01

  article

  Introduction: Fibrillary glomerulonephritis (FGN) is a rare progressive renal disease that is defined by the presence of randomly oriented non-branching fibrils showing positive immunostaining for DnaJ homolog subfamily B member 9 (DNAJB9). Recurrent FGN in renal allografts have been described with an indolent course. We report a case of donor-derived FGN in a renal allograft. Case Description: A 73-year-old female with history of end-stage renal disease (ESRD) due to anti-myeloperoxidase antibody-associated pauci-immune glomerulonephritis received a preemptive deceased donor renal transplant from a 62-year-old 79% Kidney Donor Profile Index female. The patient experienced slow graft function and nadir serum creatinine (Cr) of 1.7 mg/dL at 4 months post-transplant with subsequent Cr stabilizing in the 2.0-2.3 mg/dL range. Proteinuria mainly fluctuated between 1-2 g/g. Time-0 biopsy demonstrated mild mesangial widening/hypercellularity with rare glomerular capillary double contours. Ancillary studies revealed positive staining for DNAJB9 and kappa light chain-restriction, consistent with donor-derived FGN. 4-month surveillance biopsy showed similar findings. Background renal parenchyma showed moderate chronicity with prominent chronic vascular disease. At 10-months post-transplant, Cr remains at ˜2 mg/dL and proteinuria remained in the 1-1.6 g/g range. Discussion: FGN carries a poor prognosis with nearly half of patients progressing to ESRD within a few years. A case series of recurrent FGN after kidney transplantation suggests a relatively benign clinical course including a single report of donor-derived FGN (from a living related donor) without proteinuria in the recipient. Our case shows a more severely afflicted allograft that resulted in persistent low-grade but stable proteinuria in the recipient. Suboptimal Cr was also observed following transplant as well, although the allograft had other factors such as chronicity and chronic vascular disease.

  PublisherDOI

• Kidneys with Kidney Donor Profile Index (KDPI) >85% Can Be Used Successfully in Older Recipients

  Journal of the American Society of Nephrology · 2021-10-01

  article1st authorCorresponding

  Background: Kidneys with KDPI>85% have high discard rate approaching 50%, transplanted elderly patients over the age of 55 have lower risk of all cause mortality and death caused by cardiovascular disease compaired to their counterparts on dialysis .We present one year clinical outcomes of High KDPI > 85% kidneys when transplanted in elderly recipients. Methods: Retrospective analysis of kidneys with KDPI >85% transplanted in UC Davis Medical Center between 1/1/ 2016 and 12/30/2018 Results: 67 patients received kidneys with KDPI >85% between 1/1/2016 and 12/30/2018, 77.5% were males, 52.2% diabetics, mean recipient age was 64.3years, 41.8% developed delayed graft function staying on dialysis for a mean of 17 days, 82% were alive after one year, 3 kidneys failed 81.5 % of kidneys were functioning after one years with amean creatinine of 1.4mg/dl. Conclusions: KDPI >85% kidneys can be used successfully in older kidney recipients avoiding dialysis exposure and expanding the donor poolRecipient characteristics

  PublisherDOI

• Donor-Derived Leukocyte Chemotactic Factor 2 Amyloidosis in Renal Allografts

  Journal of the American Society of Nephrology · 2021-10-01

  article
  PublisherDOI

• Glomerular Congestion Secondary to Renal Vein Stenosis After Kidney Transplant

  Journal of the American Society of Nephrology · 2020-10-01

  article1st authorCorresponding

  Introduction: Renal vein stenosis (RVS) post kidney transplant is uncommon complication, especially when it causes severe glomerular congestion, and AKI We present a case of RVS 3 months post kidney transplant with kidney biopsy showing severe glomerular congestion Case Description: 33 y old male CKD secondary to HTN underwent LKT, smooth post op course discharged with a creatinine of 1.1mg/dl presented for 3 months protocol biopsy with creatinine of 1.5mg/dl, kidney biopsy showed severe glomerular congestion No rejection figure1, Doppler US showed suspicion for renal vein stenosis. Renal venogram demonstrated narrowing of the transplant renal vein at the anastomosis with the right common iliac vein figure 2 Successful 10 mm angioplasty balloon was inflated along the narrowed segment follow up creatinine back to 1.1mg/dl Discussion: Transplant RVS is a rare vascular complication after renal transplantation that may cause graft dysfunction. Correction of RVS with either angioplasty or stent placement is safe and effective approach. Our patient presneted with AKI and severe glomerular congestion that warranted doppler US, the finding of RVS and glomerular congestion from back pressure warranted urgent venogram and angioplasty with excellent results. Conclusion : in evaluating AKI post kidney transplant ureteral obstruction, rejection, CNI toxicity and renal artery stenosis should be ruled out if all negative RVS should be evaluatedGlomerular congestion on kidney biopsyRenal vein stenosis with post stenosis dilation

  PublisherDOI

• Tonsillar Kaposi sarcoma in a renal transplant patient

  Transplant Infectious Disease · 2020 · 18 citations

  • Medicine
  • Pathology
  • Radiology

  Kaposi sarcoma (KS) is a vascular neoplasm caused by human herpesvirus-8 (HHV-8) infection. KS is most often seen in individuals with acquired immunodeficiency syndrome but can occur in patients who are on immunosuppressive therapy. While the skin and oral mucosa are the typical sites for KS, lesions of the tonsil are quite rare with only a few reported cases. Here, we present a case of tonsillar KS occurring in a renal transplant patient. He presented with dysphagia, odynophagia, and weight loss. Oral examination revealed tonsillar hypertrophy with purple discoloration. Imaging revealed diffuse enlargement of Waldeyer's ring with enlarged right cervical lymph nodes, worrisome for post-transplant lymphoproliferative disorder. Microscopic examination of the tonsillectomy specimen showed a vascular proliferation positive for HHV-8, consistent with KS. The patient was subsequently treated with immunosuppression reduction and the addition of sirolimus, which resulted in complete resolution of oropharyngeal and cervical lesions.

  PublisherDOI

Frequent coauthors

• M. Said

  16 shared

• M.R. Laftavi

  16 shared

• R. Kohli

  16 shared

• O. Pankewycz

  16 shared

• Sunil Patel

  15 shared

• Feng Lin

  Beijing Chao-Yang Hospital

  9 shared

• T Oyama

  Oregon Health & Science University

  5 shared

• Yihung Huang

  UC Davis Health System

  5 shared

Labs

• Transplant NephrologyPI

Awards & honors

• Diamond Doctor Award, UC Davis, 2024
• Fellow of the Royal College of Physicians UK, 2005