Liver transplantation without isoniazid prophylaxis for recipients with a history of tuberculosis

Nagai, Shunji; Fujimoto, Yasuhiro; Taira, Kaoru; Egawa, Hiroto; Takada, Yasutsusgu; Kiuchi, Tetsuya; Tanaka, Kōichi

doi:10.1111/j.1399-0012.2006.00630.x

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…Isoniazid LTBI treatment for TST‐positive liver transplant candidates is controversial 13–18, 109–112. The prevalence of isoniazid‐induced acute liver failure within the general population is low (between 3.2 and 14 per 100,000 treated patients) 113–116.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

et al. 2009

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AZMycobacterium tuberculosis (MTB) causes substantial morbidity and mortality in liver transplant recipients. We examined the efficacy of isoniazid latent Mycobacterium tuberculosis infection (LTBI) treatment in liver transplant recipients and reviewed systematically all cases of active MTB infection in this population. We found 7 studies that evaluated LTBI treatment and 139 cases of active MTB infection in liver transplant recipients. Isoniazid LTBI treatment was associated with reduced MTB reactivation in transplant patients with latent MTB risk factors (0.0% versus 8.2%, P ϭ 0.02), and isoniazid-related hepatotoxicity occurred in 6% of treated patients, with no reported deaths. The prevalence of active MTB infection in transplant recipients was 1.3%. Nearly half of all recipients with active MTB infection had an identifiable pretransplant MTB risk factor. Among recipients who developed active MTB infection, extrapulmonary involvement was common (67%), including multiorgan disease (27%). The short-term mortality rate was 31%. Surviving patients were more likely to have received 3 or more drugs for MTB induction therapy (P ϭ 0.003) and to have been diagnosed within 1 month of symptom onset (P ϭ 0.01) and were less likely to have multiorgan disease (P ϭ 0.01) or to have experienced episodes of acute transplant rejection (P ϭ 0.02). Compared with the general population, liver transplant recipients have an 18-fold increase in the prevalence of active MTB infection and a 4-fold increase in the case-fatality rate. For high-risk transplant candidates, isoniazid appears safe and is probably effective at reducing MTB reactivation. All liver transplant candidates should receive a tuberculin skin test, and isoniazid LTBI treatment should be given to patients with a positive skin test result or MTB pretransplant risk factors, barring a specific contraindication. Liver Transpl 15:894-906, 2009.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

et al. 2009

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“…Liver transplant recipients may present a high risk of hepatotoxicity with isoniazid prophylaxis . Some authors consider that this risk outweighs any potential benefits in relation to the fairly low frequency of TB reactivation compared with the possibility of liver dysfunction and the need for emergency transplant .…”

Section: Prevention (Treatment Of Latent Tuberculosis Infection)mentioning

confidence: 99%

Mycobacterial infections in solid organ transplant recipients

Meije

Piersimoni

Torre‐Cisneros

et al. 2014

Clinical Microbiology and Infection

111

116

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Mycobacterial infections represent a growing challenge for solid organ transplant recipients (SOT). The adverse effects of tuberculosis (TB) therapy present a major difficulty, due to the interactions with immunosuppressive drugs and direct drug toxicity. While TB may be donor-transmitted or community-acquired, it usually develops at a latent infection site in the recipient. Pre-transplant prevention efforts will improve transplant outcomes and avoid the complications associated with post-transplant diagnosis and treatment. The present review and consensus manuscript is based on the updated published information and expert recommendations. The current data about epidemiology, diagnosis, new regimens for the treatment of latent TB infection (LTBI), the experience with rifamycins for the treatment of active TB in the post-transplant period and the experience with isoniazid for LTBI in the liver transplant population, are also reviewed. We attempt to provide useful recommendations for each transplant period and problem concerning mycobacterial infections in SOT recipients.

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“…The issue of isoniazid hepatotoxicity is particularly relevant in the context of LT. It is believed that in comparison with other solid organ transplant recipients, LT recipients could be more vulnerable to the hepatotoxicity associated with antituberculous agents 1, 14, 16, 25. This hepatotoxicity may be confused with abnormal liver function tests due to rejection or any other cause of allograft dysfunction and can increase potential drug interactions 26.…”

Section: Discussionmentioning

confidence: 99%

Chemoprophylaxis with isoniazid in liver transplant recipients

et al. 2012

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A patient receiving a liver graft needs to be treated with immunosuppressive drugs to avoid rejection. These kinds of drugs predispose the patient to the reactivation of latent infections such as tuberculosis (TB). Therefore, it is necessary to establish treatment regimens to prevent this. We retrospectively analyzed all consecutive patients undergoing liver transplantation (LT) at our center between January 1, 2000 and December 31, 2010. Latent tuberculosis infections (LTBIs) were diagnosed with positive tuberculin skin test results. After LT, infected patients were treated with isoniazid for 6 months; the treatment began soon after transplantation, and the patients were followed until the end of the study. During this period, 53 patients had LTBI data. All these patients were treated with isoniazid after LT. The median observation period after LT was 52 months (range ¼ 12-129 months). No cases of TB reactivation were reported during follow-up. Only 4 patients presented alterations in liver enzymes related to this treatment, and they showed clear improvement after the treatment was stopped. None of these patients showed severe graft dysfunction. In conclusion, preventive isoniazid appears to be a safe drug for use in LTBI patients after LT. The treatment may be established just after LT without important graft dysfunction or severe consequences for the patient. Liver Transpl 18:1110-1117, 2012. V C 2012 AASLD.Received September 28, 2011; accepted March 12, 2012.A patient receiving a liver graft needs to be treated with immunosuppressive drugs to avoid rejection. These kinds of drugs predispose the patient to the reactivation of latent infections such as tuberculosis (TB). The incidence of TB is 36 to 74 times greater than the incidence in the general population and varies from 0.35% to 15% according to the endemicity of the area.

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Liver transplantation without isoniazid prophylaxis for recipients with a history of tuberculosis

Cited by 13 publications

References 17 publications

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

Tuberculosis in liver transplant recipients: A systematic review and meta-analysis of individual patient data

Mycobacterial infections in solid organ transplant recipients

Chemoprophylaxis with isoniazid in liver transplant recipients

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