Outcome of latent tuberculosis infection in solid organ transplant recipients over a 10-year period.

Abstract

BACKGROUND:

Screening and therapy of latent tuberculosis infection (LTBI) is recommended in solid organ transplant (SOT). However, there are limited data on the tolerability of LTBI therapy pretransplant and posttransplant. We studied the tolerability of LTBI therapy and effectiveness of a centralized LTBI treatment program in a low-risk population.

METHODS:

Provincial TB and transplant databases were retrospectively reviewed for LTBI therapy referrals in SOT candidates and recipients over a 10-year period. Using univariate logistic regression, we examined factors associated with failure to complete therapy and followed patients for active TB.

RESULTS:

From 2001 to 2010, 200/461 SOT candidates referred to the TB program (43.4%) were eligible for therapy for LTBI. Eleven patients refused therapy. The remaining patients (n=189) were initially prescribed isoniazid (73%), rifampin (12.7%), or another regimen (14.3%). Adequate LTBI therapy occurred in 122 (64.5%). Patients who were liver transplant candidates or recipients were less likely to complete therapy than nonliver transplant patients (OR, 0.20; P<0.001) as were patients treated in the posttransplant phase (OR, 0.47; P=0.034). Liver enzyme elevation led to discontinuation of therapy more often in liver transplant candidates and recipients (OR, 10.48; P<0.001) and posttransplant treatment (OR, 3.50; P=0.019). In 599.4 patient-years of follow-up posttransplant (mean, 4.9 year/patient), there were no cases of active TB.

CONCLUSION:

A centralized referral program for LTBI therapy in transplant candidates is effective to prevent TB reactivation posttransplant. A significant proportion of liver transplant candidates and recipients do not tolerate standard LTBI therapy. Alternative therapies for these patients should be evaluated.

• Authors: Aman Sidhu, Geetika Verma, Atul Humar, Deepali Kumar
• Journal: Transplantation (Transplantation) Vol. 98 Issue 6 Pg. 671-5 (Sep 27 2014) ISSN: 1534-6080 [Electronic] United States
• PMID: 24825525 (Publication Type: Journal Article)

Chemical References

• Antitubercular Agents
• Rifampin

Topics

• Adult
• Aged
• Antitubercular Agents (administration & dosage)
• Cohort Studies
• Female
• Follow-Up Studies
• Humans
• Kidney Transplantation (adverse effects)
• Latent Tuberculosis (complications)
• Liver (enzymology)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Mycobacterium tuberculosis
• Organ Transplantation (adverse effects)
• Postoperative Complications
• Regression Analysis
• Retrospective Studies
• Rifampin (administration & dosage)
• Risk Factors
• Transplant Recipients
• Treatment Outcome
• Tuberculin Test