title: Risk factors for hepatotoxicity in solid organ transplants recipients being treated for tuberculosis.
abstract: BACKGROUND
  Tuberculosis (TB) is associated with high morbidity and mortality in solid organ transplant (SOT) recipients. Also, SOT patients have a 20- to 74-fold increase in the chance of developing TB compared to the general population. Here we evaluated the incidence of hepatotoxicity in SOT recipients on treatment for TB and determined risk factors for liver toxicity in these patients.
  
  
  METHODS
  Retrospective cohort conducted in a reference hospital for SOT in Southern Brazil. All SOT recipients who underwent TB treatment during the years 2000-2012 were considered for the study.
  
  
  RESULTS
  A total of 69 patients were included in the study and 23 had liver toxicity (incidence 33.3%). Independent risk factors for hepatotoxicity were rifampin use at doses of ≥600 mg daily (P = .016; OR 2.47; 95% CI, 1.18-5.15) and lung transplantation (P = .017; OR 2.05; 95% CI, 1.14-3.70). Kidney transplantation appeared as a protective factor (P = .036; OR 0.50; 95% CI, 0.26-0.96). Mortality was higher in the patients who had hepatotoxicity (43.5%), compared with those who did not (19.6%).
  
  
  CONCLUSIONS
  In this study, the use of rifampin at doses of 600 mg daily or higher was found to be an independent risk factor for liver toxicity in SOT recipients. The importance of additional risk factors for hepatotoxicity, such as lung transplantation as well as the protective role of kidney transplantation, should be better investigated in SOT recipients being treated for TB.
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Schultz
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
authors.forename: C A
authors.initials: CA
authors.lastname: Marroni
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: C S
authors.initials: CS
authors.lastname: Amorim
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
authors.forename: L F
authors.initials: LF
authors.lastname: Baethgen
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil. Electronic address: pasqualotto@santacasa.tche.br.
authors.forename: A C
authors.initials: AC
authors.lastname: Pasqualotto
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents