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


CONCLUSIONS
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.
1 Multi-organ Transplant Program, University Health Network, Toronto, Ontario, Canada. 2 University of Alberta, Edmonton, Alberta, Canada. 3 Address correspondence to: Deepali Kumar, M.D., M.Sc., F.R.C.P(C), Transplant Infectious Diseases and Multi Organ Transplant Program, University Health Network, 585 University Ave., Munk Building 11-1235, Toronto ON M5G 2N2, Canada.
Aman
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Sidhu
Geetika
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Verma
Atul
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Humar
Deepali
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Kumar
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D055985:Latent Tuberculosis / Q000150:complications*; D008099:Liver / Q000201:enzymology; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D012044:Regression Analysis; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014374:Tuberculin Test
D000995:Antitubercular Agents; D012293:Rifampin