Successful Use of Rifamycin-Sparing Regimens for the Treatment of Active Tuberculosis in Lung Transplant Recipients

Almaghrabi, Reem S.; Nizami, Imran; Alameer, Reem; Alshehri, Nada; Almohaizeie, Abdullah; Alrajhi, Abdulrahman A.; Omrani, Ali S.

doi:10.6002/ect.2020.0277

Cited by 2 publications

(5 citation statements)

References 40 publications

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“…One center used INH, EMB, and a fluoroquinolone for up to 18 months with reported success in liver transplant recipients [60]. Another center used INH, EMB, PZA, and moxifloxacin in seven lung transplant recipients for 9-12 months with good safety and efficacy, though INH was changed to RFB in two cases because of INH resistance [59]. Improved outcomes and reduced rejection with RIF-sparing regimen were reported in one series [56].…”

Section: Management Of Tuberculosis Diseasementioning

confidence: 99%

“…The decreased prevalence of 'classic' chest radiograph findings in SOT recipients [11,53,59] has biologic plausibility [70]. Lung injury in TB-infected patients is typically mediated by complex hostpathogen interactions, with cytokines (e.g.…”

Section: Management Of Tuberculosis Diseasementioning

confidence: 99%

“…Posttransplant TB can present with fever alone mandating a high clinical suspicion, particularly in those with risk factors [11,13,53,56,58,59]. Pulmonary TB (PTB) is generally common (47–87%), followed by extrapulmonary TB (EPTB) (11–41%), disseminated (2–23%), and miliary TB (2–8%) [3 ▪ ,8 ▪ ,9,10,13,53,54 ▪▪ ,56,57].…”

Section: Management Of Tuberculosis Diseasementioning

confidence: 99%

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Mycobacterium tuberculosis in solid organ transplant donors and recipients

Malinis

Koff

2021

Current Opinion in Organ Transplantation

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Purpose of review Due to impaired immune response, solid organ transplant (SOT) recipients are susceptible to tuberculosis (TB) and its subsequent morbidity and mortality. Current prevention strategies, diagnostic and treatment approach to TB infection in donors and recipients were reviewed in this article. Recent findings Screening of latent tuberculosis infection (LTBI) in donors and recipients is the cornerstone of TB-preventive strategy in recipients and requires an assessment of TB risk factors, TB-specific immunity testing, and radiographic evaluation. Interferon-gamma release assay has superseded the tuberculin skin test in LTBI evaluation despite its recognized limitations. LTBI treatment should be offered to transplant candidates and living donors before transplantation and donation, respectively. Diagnosis of TB disease can be challenging because of nonspecific clinical presentation in the recipient and is limited by the sensitivity of current diagnostics. The approach to LTBI and TB disease treatment is similar to the general population, but can be challenging because of potential drug interactions and toxicities. Summary The appropriate evaluation of donors and recipients for TB can mitigate posttransplant TB disease. Current approaches to diagnosis and treatment parallels that of immunocompetent hosts. Future research evaluating existing and novel diagnostics and treatment in transplant recipients is needed.

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Section: Management Of Tuberculosis Diseasementioning

confidence: 99%

Section: Management Of Tuberculosis Diseasementioning

confidence: 99%

Section: Management Of Tuberculosis Diseasementioning

confidence: 99%

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Mycobacterium tuberculosis in solid organ transplant donors and recipients

Malinis

Koff

2021

Current Opinion in Organ Transplantation

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“…[13][14][15] Therefore, a rifampin-sparing regimen has been attempted in SOT recipients to avoid this risk of lower bioavailability of an immunosuppressive agent. 16,17 Alternatively, rifabutin can be chosen as a reliable substitute to rifampin in these patients, 18,19 considering that rifabutin has comparable potent activity against M. tuberculosis with rifampin, 20 although rifabutin is a less potent inducer of the cytochrome P450 3A4 microsomal enzyme. [21][22][23] However, as previous studies on the clinical experience of the use of rifabutin in SOT recipients have been limited, little is known about the change in the drug level and need for dose adjustment of calcineurin inhibitor when calcineurin inhibitor used with rifabutin.…”

Section: Introductionmentioning

confidence: 99%

“…However, as rifampin is a potent inducer of the cytochrome P450 3A4 microsomal enzyme, its use inadvertently results in the development of acute rejection or graft loss when it is administered with calcineurin inhibitors by reducing the blood levels of calcineurin inhibitors 13–15 . Therefore, a rifampin‐sparing regimen has been attempted in SOT recipients to avoid this risk of lower bioavailability of an immunosuppressive agent 16,17 . Alternatively, rifabutin can be chosen as a reliable substitute to rifampin in these patients, 18,19 considering that rifabutin has comparable potent activity against M. tuberculosis with rifampin, 20 although rifabutin is a less potent inducer of the cytochrome P450 3A4 microsomal enzyme 21–23 …”

Section: Introductionmentioning

confidence: 99%

Drug‐level change and optimal dose adjustment of tacrolimus with the use of rifabutin for treating mycobacterial disease in solid organ transplant recipients

Kim

Shim

2022

Transplant Infectious Dis

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Background:Little is known about the change in drug level and the need for dose adjustment of calcineurin inhibitor when it is used with rifabutin in solid organ transplant (SOT) recipients. We aimed to analyze whether the drug level of tacrolimus significantly reduced after the use of rifabutin and to assess optimal adjustment of tacrolimus dose in SOT recipients.Methods: Of the SOT recipients in a tertiary referral center in South Korea in 2000-2019, 50 patients who maintained an unchanged dose of tacrolimus after the use of rifabutin for treating mycobacterial disease were enrolled. Their medical records were reviewed retrospectively. Results:The mean age of the patients was 53.9 ± 11.5 years. The most commonly transplanted organ was the liver (66.0%). The most common indication of rifabutin use was for treating active tuberculosis (78.0%). After rifabutin initiation, the trough level of tacrolimus decreased significantly to the subtherapeutic range in 38 (76.0%) patients.The drug levels of these 38 patients dropped from 7.2 to 3.8 ng/ml (p < .001) after rifabutin treatment. In these patients, the median 1.5-fold increase in the tacrolimus dose was required to restore the drug level to the within-therapeutic range. Conclusions:These findings indicate that careful tacrolimus drug-level monitoring and dose adjustment are necessary for most SOT recipients when rifabutin is administered for the treatment of mycobacterial disease.

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Successful Use of Rifamycin-Sparing Regimens for the Treatment of Active Tuberculosis in Lung Transplant Recipients

Cited by 2 publications

References 40 publications

Mycobacterium tuberculosis in solid organ transplant donors and recipients

Mycobacterium tuberculosis in solid organ transplant donors and recipients

Drug‐level change and optimal dose adjustment of tacrolimus with the use of rifabutin for treating mycobacterial disease in solid organ transplant recipients

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