Hyperbilirubinemia during Quinupristin-Dalfopristin Therapy in Liver Transplant Recipients: Correlation with Available Liver Biopsy Results
作者:Peter K. Linden、François Bompart、Sharon Gray、George H. Talbot
DOI:10.1592/phco.21.7.661.34580
日期:2001.6
Study Objective. To review the liver histopathology in transplant recipients who developed hyperbilirubinemia during therapy with quinupristin-dalfopristin, a new streptogramin antibiotic, and to ascertain whether objective histologic evidence of adverse drug effect could be correlated to serum bilirubin levels. Design. Retrospective analysis. Setting. University of Pittsburgh Medical Center. Patients. From a database of 34 liver recipients who received quinupristin-dalfopristin for vancomycin-resistant Enterococcus faecium infection who were prospectively enrolled in a multicenter, open-label, emergency-use protocol, the data for a subset of 25 patients who underwent one or more liver biopsies during therapy were reviewed for this study. Interventions. Quinupristin-dalfopristin was administered intravenously at 7.5 mg/kg every 8 hours. Available serum bilirubin levels from before, during, and 1 week after therapy were tabulated. Liver biopsy results obtained within 1 week before and during therapy were retrospectively reviewed. Histopathologic results were characterized and correlated to bilirubin level. Measurements and Main Results. Cholestatic changes were already present in 15 of 17 patients who underwent biopsy before therapy. During therapy, the most common findings from 40 biopsies (25 patients) were cholestasis (33 biopsies), acute rejection (10), and periportal inflammation (8). There was no evidence of drug-specific histopathologic injury. Conclusion. Hyperbilirubinemia in these patients was likely multifactorial and most frequently due to sepsis and prior graft injury.
研究目的:回顾在接受新型链霉素抗生素奎普利斯丁-达尔普利斯丁治疗期间出现高胆红素血症的肝脏移植受者的肝脏组织病理,并确定与血清胆红素水平是否存在相关的客观组织学证据表明药物不良反应。
设计:回顾性分析。
设置:匹兹堡大学医学中心。
患者:从一项前瞻性入组的多中心开放标签紧急使用协议的数据库中,筛选出34例因耐万古霉素的肠球菌感染而接受奎普利斯丁-达尔普利斯丁治疗的肝脏移植受者,并对其中25例在治疗期间进行过一次或多次肝活检的患者的数据进行了回顾。
干预:奎普利斯丁-达尔普利斯丁通过静脉注射,每8小时7.5毫克/千克进行给药。在治疗前、治疗期间及治疗后1周内的血清胆红素水平进行了汇总。治疗前1周内及治疗期间获得的肝活检结果进行了回顾性分析。对组织病理结果进行了表征并与胆红素水平相关联。
测量及主要结果:在接受活检的17名患者中,已有15名在治疗前出现肝胆汁淤积变化。在治疗期间,从40个活检(25名患者)中最常见的发现包括胆汁淤积(33个活检)、急性排斥反应(10个)和门周围炎症(8个)。未发现特定于药物的组织病理损伤证据。
结论:这些患者的高胆红素血症可能是多因素的,最常见的原因是脓毒症和先前的移植物损伤。