Results of Implementation of Preventive Recommendations for Tuberculosis After Renal Transplantation in an Endemic Area

Abstract

This retrospective cohort study assessed the results of the implementation of preventive recommendations for tuberculosis (TB) among renal transplant recipients in an endemic area (Rio de Janeiro, Brazil). Subjects were defined as at high risk for TB if they had latent tuberculosis infection (LTBI), reported recent close contact with individuals with TB or received a graft from a donor with LTBI. A 6-month course of isoniazid preventive therapy (IPT) was targeted to high-risk subjects. The study end point was TB confirmed by culture. Altogether, 535 patients were included. Median follow-up was 59 months. The overall cumulative incidence of TB was 2.1% while among the 274 patients in whom the preventive protocol was fully implemented, the incidence was only 0.7%. The incidence of TB among 75 high-risk recipients not treated with isoniazid (7%) was significantly higher than that observed in 209 untreated low-risk patients (1%, p ¼ 0.006) and in 65 high-risk subjects that received IPT (no case, p ¼ 0.03). In conclusion, the implementation of preventive recommendations for TB in an endemic area allowed the appropriate discrimination between high-and low-risk renal transplant recipients and was associated with long-term reduction in the incidence of this complication among high-risk subjects.

Mycobacterium Tuberculosis in Solid Organ Transplantation: Incidence before and after Expanded Isoniazid Prophylaxis

“…As reported by others, the use of "universal" isoniazid prophylaxis in living-related kidney transplantation in an endemic area resulted in reduced numbers of active tuberculosis after transplantation. [20][21][22] WHO estimates the incidence rates of tuberculosis in Saudi Arabia to be 14 per 100 000 in 2013 (range, 12-16 per 100 000). 13 The prevalence of LTBI (defined as TST reaction of ≥10 mm) in the general population was reported in a nationwide survey in 1993 to be 33% in people without prior BCG vaccination.…”

Latent Tuberculosis Infection: Is Universal Screening the Right Approach?

“…We have read with interest the article by de Lemos et al (1) regarding the implementation of a preventive protocol for latent tuberculosis infection (LTBI) in kidney transplant recipients residing in Brazil. In that study, all recipients and living donors were intended to be screened preoperatively or at the time of transplantation for epidemiological, clinical and radiological evidence of LTBI.…”

Treatment of latent TB Infection and the risk of tuberculosis after solid organ transplantation: Comprehensive review

“…Our extensive review of the literature identified four other detailed case reports that documented the development of active TB disease after LTBI treatment . In addition, we found a total of 56/2651 (2.1%) cases of active TB among 41 observational cohorts and six RCT . Among them, only five cases were described in detail.…”

“…We found 41 cohort studies that evaluated the outcome of LTBI therapy. Eleven were from Europe, 10 from US and Asia, seven from South America, and one each from Africa, Australia, and Canada . Only nine were prospective .…”

“…Only nine were prospective . Most studies included kidney (22) and liver (12) transplant recipients only. There were three studies on lung and four on multiple organ transplants .…”