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Changes in liver biochemistry and tacrolimus levels following the introduction of elexacaftor/tezacaftor/ivacaftor in patients with cystic fibrosis and liver transplant. J Cyst Fibros 2024; 23:99-102. [PMID: 37164896 DOI: 10.1016/j.jcf.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Elevated liver function tests (LFTs) are reported in individuals with cystic fibrosis (CF) starting elexacaftor/tezacaftor/ivacaftor (ETI). We report our experience with ETI in CF liver transplant patients. METHOD All CF liver transplant patients under the care of the Leeds CF team were commenced on ETI. Liver biopsies were performed when ALT >3 times upper limit of normal with or without bilirubin elevation. Treatment was guided by transplant hepatology and CF teams. Clinical data including lung function, LFTs and tacrolimus levels were collected. RESULTS Four patients (3 male, 1 female) on tacrolimus were commenced on ETI. Median time post liver transplantation was 6.5 years. Three patients underwent liver biopsy. One biopsy was abnormal with immune-mediated liver injury, which responded to increased immunosuppression. Management of tacrolimus levels proved straightforward. CONCLUSION ETI therapy in CF post liver transplant recipients was encouraging. Normal liver biopsy provides re-assurance to continue treatment despite elevated LFTs.
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WS02.06 Can liver biopsy guide the management of deranged liver function tests in liver transplant recipients receiving Kaftrio? J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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P206 Patient feedback following the introduction of a dedicated ‘Symkevi® Initiation Clinic’ prior to starting modulator therapy. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01231-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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WS12.6 Different CFTR modulator combinations downregulate inflammation differently in cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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P251 “It’s an absolute life-changing device”- adults with Cystic Fibrosis-Related Diabetes experiences of the Freestyle Libre (FSL) flash glucose monitoring system. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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P253 Use of ivacaftor (IVA) in patients heterozygous for R117H mutation: real-life experience in a large UK adult CF centre. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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WS11-4 Current clinical practice in the management of cystic fibrosis-related bone disease in a regional UK adult cystic fibrosis centre. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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P255 Clinical stabilisation following ivacaftor in patients with cystic fibrosis, severe lung disease and rare CFTR mutation: a report of two cases. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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P444 Improving advanced care planning discussions in a regional adult cystic fibrosis unit. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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ePS5.02 The effect of providing patient online access to Electronic Health care Records (EHR) in cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Use of ceftazidime/avibactam for the treatment of MDR Pseudomonas aeruginosa and Burkholderia cepacia complex infections in cystic fibrosis: a case series. J Antimicrob Chemother 2019; 74:1425-1429. [DOI: 10.1093/jac/dky558] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/26/2022] Open
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P237 Views of healthcare professionals on patients having access to their secondary care electronic healthcare record: results of a cross-sectional questionnaire. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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P124 Bicarbonate and oxygen saturation predict the need for fitness to fly test in patients with cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Intravenous fosfomycin for pulmonary exacerbation of cystic fibrosis: Real life experience of a large adult CF centre. Pulm Pharmacol Ther 2018; 50:82-87. [PMID: 29660401 DOI: 10.1016/j.pupt.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/15/2018] [Accepted: 04/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The increased prevalence of multi-drug resistant strains of P.aeruginosa and allergic reactions among adult patients with cystic fibrosis (CF) limits the number of antibiotics available to treat pulmonary exacerbations. Fosfomycin, a unique broad spectrum bactericidal antibiotic, might offer an alternative therapeutic option in such cases. AIM To describe the clinical efficacy, safety and tolerability of intravenous fosfomycin in combination with a second anti-pseudomonal antibiotic to treat pulmonary exacerbations in adult patients with CF. METHOD A retrospective analysis of data captured prospectively, over a 2-years period, on the Unit electronic medical records for patients who received IV fosfomycin was performed. Baseline characteristics in the 12 months prior treatment, lung function, CRP, renal and liver function and electrolytes at start and end of treatment were retrieved. RESULTS 54 patients received 128 courses of IV fosfomycin in combination with a second antibiotic, resulting in improved FEV1 (0.94 L vs 1.24 L, p < 0.01) and reduced CRP (65 mg/L vs 19.3 mg/L, p < 0.01). Renal function pre- and post-treatment remained stable. 4% (n = 5) of courses were complicated with AKI at mid treatment, which resolved at the end of the course. Electrolyte supplementation was required in 18% of cases for potassium and magnesium and 7% for phosphate. Nausea was the most common side effect (48%), but was well controlled with anti-emetics. CONCLUSION Antibiotic regimens including fosfomycin appear to be clinically effective and safe. Fosfomycin should, therefore, be considered as an add-on therapy in patients who failed to respond to initial treatment and with multiple drug allergies.
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EPS3.10 Pregnancy in women with CF: Improved clinical outcomes 1990–2016. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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288 Losartan-associated sprue-like enteropathy in a post-lung transplant cystic fibrosis patient. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30627-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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134 Does Pandoraea cause clinical deterioration in adults with cystic fibrosis? J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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WS16.4 What functionality do patients want from an Electronic Clinical Record (ECR). J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42 Dramatic clinical stabilisation following introduction of ivacaftor in an adult patient with cystic fibrosis (CF) and R117H/5T mutation. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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49 The use of positron emission tomography (PET) in adult patients with cystic fibrosis (CF). J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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P234 Prevalence of Non-pulmonary complications following Lung transplantation in adult patients with Cystic Fibrosis (CF): Abstract P234 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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199 Metabolic alkalosis in patients with cystic fibrosis: Are we missing something? J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33 Procalcitonin and C reactive protein levels in hospitalised patients receiving intravenous antibiotics. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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121 Extended HLA analysis in a cohort of patients hypersensitive to beta-lactam antibiotics. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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166 The prevalence and aetiology of pleural effusions and empyema in patients attending a regional adult CF centre. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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WS8.1 Lung transplant referrals and outcomes: experience of a regional adult CF centre 2008–2013. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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100 Common clone of Mycobacterium abscessus identified among adults and children in a large UK CF Centre. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60236-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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124 The prevalence and financial impact of beta-lactam allergy in CF. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60260-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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150 The impact of viral symptoms on rhinovirus positive pulmonary exacerbations in patients with CF. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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164 Incidence, management and outcomes following spontaneous pneumothorax in adult patients with CF attending a Regional Centre. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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159 Frequency and pathogenicity of individual rhinovirus species during adult exacerbations. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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146 Trombones – A potential source of recurrent Burkholderia cepacia complex infection? J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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WS18.5 When women with CF become mothers: A qualitative study on psychosocial impact and adjustment. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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The use of nebulised aztreonam lysine (AZLI) in aztreonam hypersensitive patients. J Cyst Fibros 2012; 11:353. [DOI: 10.1016/j.jcf.2012.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
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WS4.4 The effect of remote monitoring and third party intervention on adherence with inhaled therapies in patients with cystic fibrosis using the I-neb Insight Online patient management system. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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105 The addition of broth culture increases the sensitivity of cough swabs for the detection of P. aeruginosa from people with CF. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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WS13.3 Reduction in prevalence of osteoporosis and osteopenia in adult patients attending a regional UK centre: 2011 vs. 1999. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60093-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rapid desensitization for non-immediate reactions in patients with cystic fibrosis. J Cyst Fibros 2011; 10:282-5. [DOI: 10.1016/j.jcf.2011.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 01/13/2011] [Accepted: 02/04/2011] [Indexed: 11/26/2022]
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144 Sputum and bronchoalveolar lavage in diagnosing ‘atypical’ infections. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The use of acetazolomide in adults with cystic fibrosis and hypercapnia. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tolerability of nebulised vancomycin in adults with cystic fibrosis. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Clinical impact of H1N1 compared to other viral infections in pulmonary exacerbations of cystic fibrosis. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60143-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Financial savings following the introduction of a cystic fibrosis electronic patient record system. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60446-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fatherhood in males with cystic fibrosis: modality of conception and impact on clinical status. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Capillary blood gas sampling at annual assessment – a service review. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nutritional decline in cystic fibrosis related diabetes: the effect of intensive nutritional intervention. J Cyst Fibros 2009; 8:179-85. [PMID: 19179122 DOI: 10.1016/j.jcf.2008.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 12/12/2008] [Accepted: 12/23/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reports indicate that nutritional and respiratory decline occur up to four years prior to diagnosis of cystic fibrosis related diabetes (CFRD). Our aim was to establish whether intensive nutritional intervention prevents pre-diabetic nutritional decline in an adult population with CFRD. METHODS 48 adult patients with CFRD were matched to 48 controls with CF, for age, gender and lung pathogen status. Nutritional and other clinical indices were recorded at annual intervals from six years before until two years after diagnosis. Data were also analysed to examine the impact of early and late acquisition of CFRD. RESULTS No important differences in weight, height, body mass index (BMI), lung function or intravenous treatment were found between groups in the six years prior to diagnosis, nor any significant deviation over time. In those who developed diabetes, use of overnight enteral tube feeding (ETF) was four times as likely at the time of diagnosis, compared to controls [ETF 43.8% (CFRD) v 18.8% (CF Controls), OR 4.0, CI 1.3 to 16.4, p=0.01]. Age at onset of CFRD played a significant role in determining the pre-diabetic clinical course. Younger diabetics with continued growth at study onset (n=17) had a lower BMI from 2 years prior to diagnosis compared to controls [BMI 18.9 kg/m(2) (CFRD) v 20.8 kg/m(2) (CF Controls), diff=1.9, CI -0.1 to 3.7 p=0.04]. The BMI of older diabetics (completed growth at study onset) was equal to that of controls throughout. CONCLUSION Pre-diabetic nutritional decline is not inevitable in adults with CFRD, but is influenced by age of onset. In the group overall, those with CFRD are more likely to require ETF from 2 years prior to diagnosis. Despite intensive nutritional intervention, patients who continue to grow throughout the pre-diabetic years, show a level of nutritional decline absent in older adults.
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Acute Burkholderia cenocepacia pyomyositis in a patient with cystic fibrosis. J Cyst Fibros 2009; 8:273-5. [DOI: 10.1016/j.jcf.2009.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 04/14/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
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