利福布丁治疗实体器官移植受者结核病：回顾性观察研究和文献复习。

Rifabutin for treating tuberculosis in solid organ transplant recipients: A retrospective observational study and literature review.

机构信息

Department of Infectious Diseases and Tuberculosis Unit, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.

Liver Transplantation Unit, Bellvitge University Hospital, Barcelona, Spain.

出版信息

Transpl Infect Dis. 2021 Apr;23(2):e13471. doi: 10.1111/tid.13471. Epub 2020 Oct 7.

DOI:10.1111/tid.13471

PMID:32959494

Abstract

BACKGROUND

The treatment of tuberculosis (TB) in solid organ transplant (SOT) recipients is challenging owing to interactions between rifampin and immunosuppressive drugs. Rifabutin, a rifamycin with excellent activity against Mycobacterium tuberculosis and that induces cytochrome p450 less, may facilitate treatment. We report our experience with rifabutin for treating TB in SOT recipients and review the available literature.

METHODS

A retrospective observational study of all SOT recipients with TB between January 2000 and December 2019. The clinical characteristics and outcomes of patients treated with and without rifabutin-containing regimens were compared and a literature review was conducted.

RESULTS

We included 31 SOT recipients with TB, among whom 22 (71%) were men and the median age was 62 years (interquartile range 50-20). There were no significant differences between patients treated with rifabutin (n = 12), rifampin (n = 14), and non-rifamycins (n = 5) in clinical cure rates (83.3%, 64.3%, and 100%, respectively; P = .21), side effects (25%, 37.5%, and 20%, respectively; P = .74), or mortality (16.7%, 35.7%, and 0%, respectively; P = .21). Only one patient, treated with rifampin, suffered graft rejection. The literature review identified 59 SOT recipients with TB treated with rifabutin-containing regimens from 8 publications. Overall, the clinical cure, graft rejection, and mortality rates were 93.2%, 5.1%, and 6.8%, respectively.

CONCLUSIONS

Rifabutin-containing regimens offer a reliable alternative to rifampin when treating TB in SOT recipients.

摘要

背景

由于利福平与免疫抑制剂之间的相互作用，实体器官移植（SOT）受者的结核病（TB）治疗具有挑战性。利福布丁是一种对结核分枝杆菌具有优异活性且诱导细胞色素 p450 较少的利福霉素，可能有助于治疗。我们报告了我们在 SOT 受者中使用利福布丁治疗结核病的经验，并回顾了现有文献。

方法

这是一项对 2000 年 1 月至 2019 年 12 月期间所有患有结核病的 SOT 受者进行的回顾性观察性研究。比较了接受含利福布丁和不含利福布丁方案治疗的患者的临床特征和结局，并进行了文献复习。

结果

我们纳入了 31 例患有结核病的 SOT 受者，其中 22 例（71%）为男性，中位年龄为 62 岁（四分位距 50-20）。接受利福布丁（n=12）、利福平（n=14）和非利福霉素（n=5）治疗的患者在临床治愈率（分别为 83.3%、64.3%和 100%；P=0.21）、副作用（分别为 25%、37.5%和 20%；P=0.74）或死亡率（分别为 16.7%、35.7%和 0%；P=0.21）方面无显著差异。仅 1 例接受利福平治疗的患者发生移植物排斥反应。文献复习从 8 篇文献中确定了 59 例接受利福布丁治疗方案治疗的 SOT 受者结核病。总体而言，临床治愈率、移植物排斥率和死亡率分别为 93.2%、5.1%和 6.8%。