Tuberculosis (TB) Treatment without Rifampin in Kidney (K) and Kidney-Pancreas (KP) Transplantation (Tx)
1Infectious Diseases, ITAC (Instituto de Trasplante y Alta Complejidad), Ciudad Autonoma de Buenos Aires, Argentina, 2Internal Medicine, ITAC (Instituto de Trasplante y Alta Complejidad), Ciudad Autonoma de Buenos Aires, Argentina, 3Critical Care, ITAC (Instituto de Trasplante y Alta Complejidad), Ciudad Autonoma de Buenos Aires, Argentina, 4Kidney Transplantation, ITAC (Instituto de Trasplante y Alta Complejidad), Ciudad Autonoma de Buenos Aires, Argentina, 5Kidney Pancreas Transplantation, ITAC (Instituto de Trasplante y Alta Complejidad), Ciudad Autonoma de Buenos Aires, Argentina
Meeting: 2022 American Transplant Congress
Abstract number: 1348
Keywords: Bacterial infection, Kidney transplantation, Kidney/pancreas transplantation
Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: All Infections (Excluding Kidney & Viral Hepatitis) III
Session Type: Poster Abstract
Date: Monday, June 6, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: TB is a diagnostic and therapeutic challenge in K/KP Tx. Pharmacokinetic interaction between rifampin (RFP) and mTOR /calcineurin inhibitors (CNI) led to use of alternative regimens for TB treatment in this group of patients. Results obtained in TB treatment with RFP-free regimens in K/KP TX patients are presented.
*Methods: Retrospective review of confirmed TB cases in K /KP Tx patients. (Jan 2006-Jul 2019), defined by M.tuberculosis positive culture or PCR; o elevated adenosine deaminase (ADA) and/or characteristic histopathology findings with clinical evolution consistent with TB. Cases defined by response to empiric treatment were excluded.
*Results: 57 TB cases (50 in 2297 adults with KTx (2.2%) /7 in 364 KPTx (1.92%), Two were postmortem diagnosis (excluded from analysis). “De novo” Treatment with RFP-free regimens: 30 patients (pts) (25 KTx, 5 KPTx). Mean age: 49.24 (∓11.50) years. Induction immunosuppression (IS): 22 pts. Maintenance IS: tacrolimus-mycofenolate (MF)-steroids (E) in 13 (43%), sirolimus-MF-E in 6 (20%), Other IS regimens: 11(36%). Belatacept in 4 patients. (13%). 22 pts without rejections (R) prior to TB, (8 pts with R: Rejection rate prior to TB 0.15 episodes/year/patient). TB onset after TX: Median 28 (range 2.4- 242.3) months (m). Late onset (> 6 m): 24 cases (80%). TB: pulmonary = 13 (43%); Disseminated = 7 (23%) Extrapulmonary = 10 (33%). All patients were treated with isoniazid (IHN), ethambutol (EMB), levofloxacin (L), 12 patients also received pyrazinamide (PZN) during the first 2 m. 27 (90%) patients completed treatment with IHN-EMB-L for 6 m (1 pt), 9 m (3) o 12 m (23). In these patients, graf function remained stable (mean initial creatinine 1.5 mg%, mean creatinine at end of treatment 1.5 mg%, p=NS). One patient returned to dialysis at 4th month of treatment, and completed treatment with IHN-RFP. 2 (7%) patients died while on treatment. Among the 28 patients who completed treatment, median (range) follow-up was 32 (8-150) m. No TB relapses were observed.
*Conclusions: Rifampin-free TB treatment in K/KP Tx was safe and effective. Mortality was less than in series with a larger number of patients treated with rifampin. The use of RFP-free regimens avoided cumbersome pharmacokinetic interactions with CNI/mTOR, with excellent results in grafts function.
To cite this abstract in AMA style:
Radisic MV, Pujato N, Bravo PM, Grosso RDel, Hunter M, Beltramino S, Cornet L, Franzini RLivia, Dotta AC, Leon L, Walther J, Uva P, Werber G, Rial MC. Tuberculosis (TB) Treatment without Rifampin in Kidney (K) and Kidney-Pancreas (KP) Transplantation (Tx) [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/tuberculosis-tb-treatment-without-rifampin-in-kidney-k-and-kidney-pancreas-kp-transplantation-tx/. Accessed December 3, 2024.« Back to 2022 American Transplant Congress