Chemoprophylaxis with isoniazid in liver transplant recipients.
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 = 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.
Gastroenterology and Hepatology Unit, Faculty of Medicine, Marqués de Valdecilla University Hospital, Santander, Spain. digfge@humv.es
Emilio
E
Fábrega
Blanca
B
Sampedro
Joaquín
J
Cabezas
Fernando
F
Casafont
Miguel Ángel
MÁ
Mieses
Irene
I
Moraleja
Javier
J
Crespo
Fernando
F
Pons-Romero
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007538:Isoniazid / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000472:pathogenicity; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D055815:Young Adult
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D007538:Isoniazid