Use of rifabutin for the treatment of a latent tuberculosis infection in a patient after solid organ transplantation

Abstract

Latent tuberculosis infection is an important problem for solid organ transplant recipients because of the frequency of its occurrence and its potential for reactivation. Because of the high mortality rate associated with active tuberculosis infections in transplant recipients, guidelines from the American Thoracic Society recommend treatment for latent tuberculosis in this population. However, the choice of treatments is often difficult because liver transplant recipients may be more sensitive to isoniazid hepatotoxicity, and rifampin has significant drug interactions with the calcineurin inhibitors used for immunosuppression. Two prior case reports described success with the use of rifabutin, a rifampin alternative, as part of a multidrug treatment regimen for active tuberculosis in posttransplant patients; however, there is no prior literature describing any experience with rifabutin for the treatment of latent tuberculosis in the posttransplant setting. We present a summary of tacrolimus drug levels and corresponding dose requirements for a single posttransplant patient during the administration of 3 different latent tuberculosis drug regimens: rifampin alone, rifampin plus ketoconazole, and rifabutin. In this patient's case, rifabutin allowed the maintenance of adequate tacrolimus levels, although an approximate 2.5‐fold increase in the dose was required. Rifampin alone was associated with inadequate immunosuppressant levels, and rifampin plus ketoconazole was associated with a problematically prolonged QT interval and concerns about inadequate tuberculosis treatment. Liver Transpl 19:457–461, 2013. © 2013 AASLD.

Tuberculosis in solid organ transplant candidates and recipients

“…A case report on the use of rifabutin for LTBI after liver transplant was recently published [26]. In this patient, the use of rifabutin resulted in adequate tacrolimus levels when the tacrolimus dose was increased 2.5-fold.…”

Global access of rifabutin for the treatment of tuberculosis – why should we prioritize this?

“…Although rifabutin is not recommended as first line therapy for latent TB infection (LTBI), it has been used in liver transplant patients, who have experience isoniazid‐induced hepatoxicity and to optimize maintenance of calcineurin inhibitor levels . One pilot study (n = 44) for treatment of LTBI in people living with HIV, showed favourable ADR and completion rates comparing three months bi‐weekly rifabutin in combination with isoniazid compared with six months daily isoniazid .…”

Remedy Experience of Severe Abdominal Infection after Orthotopic Liver Transplantation

“…Bacterial translocation caused by intestinal barrier dysfunction is the main source of E coli (1,9,10). Many bacterial toxins and inflammatory mediators are absorbed into the bloodstream, increasing multiple-organ dysfunction.…”