Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Transpl Infect Dis. 2022 Aug;24(4):e13893. doi: 10.1111/tid.13893. Epub 2022 Jul 20.
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.
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.
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.
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.
在实体器官移植（SOT）受者中，环孢素与利福平丁联合使用时，环孢素的药物水平变化及其剂量调整的需求知之甚少。我们旨在分析利福平丁使用后环孢素的药物水平是否显著降低，并评估 SOT 受者中环孢素剂量的最佳调整。
在韩国一家三级转诊中心 2000 年至 2019 年的 SOT 受者中，纳入了 50 例因治疗分枝杆菌病而使用利福平丁后维持环孢素剂量不变的患者。回顾性分析其病历。
患者的平均年龄为 53.9±11.5 岁。最常移植的器官是肝脏（66.0%）。利福平丁使用的最常见指征是治疗活动性肺结核（78.0%）。利福平丁开始使用后，38 例（76.0%）患者的环孢素谷浓度显著降至治疗范围以下。这些患者的环孢素水平从治疗前的 7.2ng/ml 降至治疗后的 3.8ng/ml（p<.001）。在这些患者中，需要将环孢素剂量增加 1.5 倍中位数，才能将药物水平恢复到治疗范围内。
这些发现表明，当分枝杆菌病患者给予利福平丁治疗时，大多数 SOT 受者需要仔细监测环孢素药物水平并调整剂量。
