Latent tuberculosis in kidney and liver transplant patients: a review of treatment practices and outcomes.

Abstract

BACKGROUND:

The standard treatment of latent tuberculosis infection (LTBI) is associated with toxicities and data are limited on tolerability among patients with advanced organ disease listed for transplant. Alternate options are available, but they have yet to be studied in this population.

METHODS:

A retrospective review of the treatment of LTBI among kidney and/or liver transplant candidates was conducted to assess factors impacting therapy initiation, tolerability, and completion of therapy.

RESULTS:

Of 174 eligible patients, treatment of LTBI was initiated in 129, of which 91 were listed for kidney transplant and 38 were listed for liver or liver/kidney transplant. Infectious Diseases consultation was independently associated with treatment initiation when controlling for waitlisted organ and receipt of hemodialysis (odds ratio [OR] 81.14, 95% confidence interval [CI] 23.94-274.94, P < 0.001). Documented completion of first-line therapy was 47% overall, and 49% and 39%, respectively, among kidney and liver/kidney candidates (P = not significant). On multivariable analysis, controlling for baseline aspartate aminotransferase and waitlisted organ, first-line receipt of rifampin was associated with lower rates of treatment completion (OR 0.19, 95% CI 0.05-0.77, P = 0.02).

CONCLUSION:

Based on medical record documentation, completion of first-line therapy was <50% in this cohort, although this is likely an underestimate, as 34% of patients had no chart documentation that therapy was completed. Approximately 20% of patients did not complete first-line therapy because of adverse effects.

• Authors: S A Grim, J E Layden, P Roth, S Gallitano, W Adams, N M Clark
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 17 Issue 5 Pg. 768-77 (Oct 2015) ISSN: 1399-3062 [Electronic] Denmark
• PMID: 26263530 (Publication Type: Journal Article)
• Copyright: © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antitubercular Agents

Topics

• Adolescent
• Adult
• Aged
• Antitubercular Agents (therapeutic use)
• Drug Administration Schedule
• Female
• Humans
• Kidney Transplantation
• Latent Tuberculosis (diagnosis, drug therapy)
• Liver Transplantation
• Male
• Middle Aged
• Preoperative Care (methods)
• Retrospective Studies
• Treatment Outcome
• Young Adult