Tacrolimus concentration to dose ratio in solid organ transplant patients treated with fecal microbiota transplantation for recurrent Clostridium difficile infection

Fecal microbiota transplantation (FMT) is increasingly being performed for Clostridium difficile infection in solid organ transplant (SOT) patients; however, little is known about the potential pharmacokinetic or pharmacomicrobial effects this may have on tacrolimus levels. We reviewed the medical r...

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Bibliographic Details
Published in:Transplant infectious disease 2018-04, Vol.20 (2), p.e12857-n/a
Main Authors: Woodworth, Michael H., Kraft, Colleen S., Meredith, Erika J., Mehta, Aneesh K., Wang, Tiffany, Mamo, Yafet T., Dhere, Tanvi, Sitchenko, Kaitlin L., Patzer, Rachel E., Friedman‐Moraco, Rachel J.
Format: Article
Language:English
Subjects:
Bacteria
Biopsy
Clinical trials
Clostridium difficile
Clostridium Infections - therapy
Fecal Microbiota Transplantation
Fecal microflora
Graft rejection
Humans
Immunosuppressive Agents - blood
Immunosuppressive Agents - pharmacokinetics
Infections
Mathematical analysis
Medical records
Microbiota
Organ Transplantation - adverse effects
Patients
pharmacokinetics
Pharmacology
Recurrent infection
Retrospective Studies
Tacrolimus
Tacrolimus - blood
Tacrolimus - pharmacokinetics
Transplantation
Transplants & implants
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Summary:Fecal microbiota transplantation (FMT) is increasingly being performed for Clostridium difficile infection in solid organ transplant (SOT) patients; however, little is known about the potential pharmacokinetic or pharmacomicrobial effects this may have on tacrolimus levels. We reviewed the medical records of 10 SOT patients from September 2012‐December 2016 who were taking tacrolimus at time of FMT for recurrent C. difficile infection. We compared the differences in tacrolimus concentration/dose ratio (C/D ratio) 3 months prior to FMT vs 3 months after FMT. The mean of the differences in C/D ratio calculated as (ng/mL)/(mg/kg/d) was −17.65 (95% CI −1.25 to 0.58) (ng/mL)/(mg/kg/d), P‐value .43 by Wilcoxon signed‐rank test. The mean of the differences in C/D ratio calculated as (ng/mL)/(mg/d) was −0.33 (95% CI −1.25 to 0.58) (ng/mL)/(mg/d), P‐value .28 by Wilcoxon signed‐rank test. Of these patients, 2/10 underwent allograft biopsy for allograft dysfunction in the year after FMT, with no evidence of allograft rejection on pathology. These preliminary data suggest that FMT may not predictably alter tacrolimus levels and support its safety for SOT patients however further study in randomized trials is needed.
ISSN:1398-2273
1399-3062
DOI:10.1111/tid.12857