The Treatment of Post Transplant Tuberculosis: Rifampin Sparing Regimen.
- Author:
Sang Ju LEE
1
;
Jin A PARK
;
Yoon Kyoung CHANG
;
Bum Soon CHOI
;
Sun Ae YOON
;
Chul Woo YANG
;
Yong Soo KIM
;
Suk Young KIM
;
Yoon Sik CHANG
;
Byung Kee BANG
Author Information
1. Department of Internal Medicine, The Catholic University of Korea College of Medicine, Daejeon, Korea. alterego54@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Transplantation;
Tuberculosis;
Rifampin;
Quinolone
- MeSH:
Clinical Protocols;
Creatinine;
Cyclosporine;
Cytochrome P-450 Enzyme System;
Humans;
Incidence;
Korea;
Rejection (Psychology);
Retrospective Studies;
Rifampin;
Steroids;
Transplantation, Homologous;
Transplants;
Treatment Outcome;
Tuberculosis
- From:The Journal of the Korean Society for Transplantation
2009;23(1):22-27
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Rifampin reduces the blood levels of cyclosporin (CsA) and steroids by increasing the activity of hepatic cytochrome P450 system and the inclusion of rifampin in the anti-tuberculosis treatment protocol increases the risk of acute allograft rejection and mortality due to its interaction with cyclosporine. We report the successful treatment outcome of post-renal transplant tuberculosis patients who were treated with quinolone substituted for rifampin in anti-tuberculosis regimen. METHODS: This was a retrospective study of 14 patients with tuberculosis diagnosed among 218 transplant recipients from Feb. 1988 through Dec. 2003 at Daejeon St. Mary's hospital of catholic university of Korea and 6 patients with tuberculosis who underwent transplantation in other hospital and followed up in our hospital. RESULTS: The incidence of post-renal transplant tuberculosis was 6.4%. The mean time to diagnosis of tuberculosis after transplantation was 58.6 months (3.3~180.7). 9 were pulmonary and 11 were extrapulmonary tuberculosis. The graft failure was not occurred in quinolone group (0/15) and 2 of 3 in rifampin group. The serum creatinine levels before tuberculosis were not different to that of post-treatment in quinolone group. (P=0.58) The CsA levels before tuberculosis were not also different to that of posttreatment in quinolone group (P=0.68). CONCLUSIONS: The treatment of post-renal transplant tuberculosis with rifampin sparing anti-tuberculosis regimen was successful. Rifampin, although a mainstay drug in the treatment of tuberculosis, can be avoided in patients receiving cyclosporine, thus avoiding the risk of precipitating allograft rejection.
