Safety of treatment of latent tuberculosis infection in compensated cirrhotic patients during transplant candidacy period.
BACKGROUND
Treatment of latent tuberculosis infection with isoniazid (INH) or rifampin (RIF) is controversial in liver transplant candidates due to potential hepatotoxicity. In this study, treatment of latent tuberculosis during transplant candidacy period is explored, and relevant literature is reviewed.


METHODS
Liver transplant candidates with latent tuberculosis infection by positive tuberculin skin test (>5 mm) were prospectively enrolled and treated with 9 months of INH or 4 months of RIF, and were monitored monthly for their liver enzyme profiles, adverse effects, compliance, and completion rate.


RESULTS
Four of nine patients with INH had asymptomatic, mild elevations of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) versus none of five patients in the RIF group. Two cases of elevations were attributed to INH. Two other cases were attributed to alcoholism or active chronic hepatitis B virus infection. Only one patient in the INH group experienced symptoms possibly attributed to INH hepatotoxicity. Compliance was 100% per patient reporting. Completion rates were 79% for INH and 100% for RIF. No fulminant hepatic failure or death was observed.


CONCLUSIONS
Treatment of latent tuberculosis in liver transplant patients during their candidacy with INH or RIF appears to be a safe, viable option, if carefully monitored for adverse effects and liver enzymes.
Jahng
Alex W
AW
School of Medicine, Department of Pharmacy Services, Hospitalist Division, University of California, Irvine, Medical Center, Orange, CA 92868, USA.
Tran
Thao
T
Bui
Lanchi
L
Joyner
James L
JL
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D015897:Comorbidity; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D011300:Preoperative Care; D012293:Rifampin / Q000627:therapeutic use; D012449:Safety; D016896:Treatment Outcome; D014374:Tuberculin Test; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D007538:Isoniazid; D012293:Rifampin