Korean J Transplant.  2021 Mar;35(1):48-52. 10.4285/kjt.20.0041.

Posttransplantation tuberculosis management in terms of immunosuppressant cost: a case report in Myanmar

• Lwin PW
• Htun YY
• Myint AK
• Swe HK

• KMID: 2514408
• DOI: http://doi.org/10.4285/kjt.20.0041

Abstract

Drug interactions between anti-tuberculosis and immunosuppressive medications after renal transplantation are a common problem in Myanmar. The efficacy of both types of drugs can be reduced during the treatment period, which can lead to graft failure and flare-ups of infection. Drug adjustments, with frequent monitoring and close follow-up, are crucial in this period. Ketoconazole decreases tacrolimus metabolism by inhibiting cytochrome P450-3A5 enzymes and P-glycoprotein. It is cost effective and has been frequently used to reduce the dose and cost of tacrolimus. Here, we report the case of a 56-year-old male renal transplant recipient with anti-tuberculosis medications.

Keyword

Post renal transplant tuberculosis; Immunosuppressant cost; Drug Interaction

Figure

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  Fig. 1 Chest radiograph of the patient.

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  Fig. 2 Computed tomography scan of the patient. (A) Speculated mass lesion in right lower segments and air space opacity with internal air bronchogram. (B) Consolidation in anterior segment of right upper lobe. (C) Soft tissue lesion in right lung field with speculated margin.

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  Fig. 3 Changes in tacrolimus trough levels. a)Ketoconazole 100 mg bd added.

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  Fig. 4 Recheck chest radiograph (posteroanterior view) taken 6 months after anti-tuberculosis treatment.

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