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KMID : 0361120090230010022
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Korean Journal of Transplantation
2009 Volume.23 No. 1 p.22 ~ p.27
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The Treatment of Post Transplant Tuberculosis: Rifampin Sparing Regimen
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Lee Sang-Ju
Park Jin-A
Chang Yoon-Kyung
Choi Bum-Soon
Yoon Sun-Ae
Yang Chul-Woo
Kim Yong-Soo
Kim Suk-Young
Chang Yoon-Sik
Bang Byung-Kee
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Abstract
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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).
Conslusions: 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.
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KEYWORD
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Transplantation, Tuberculosis, Rifampin, Quinolone
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