title: Three months of weekly rifapentine plus isoniazid for latent tuberculosis treatment in solid organ transplant candidates.
abstract: BACKGROUND
  Isoniazid daily for 9 months is the recommended regimen for latent tuberculosis infection (LTBI) in solid organ transplant (SOT) candidates, but its use is controversial, due to reports of hepatotoxicity and low treatment completion rates. A 12-week course of once weekly directly observed therapy (DOT) with isoniazid plus rifapentine (3HP) is a new LTBI treatment regimen. Tolerability and safety data of 3HP LTBI treatment in SOT candidates are limited.
  
  
  METHODS
  Twelve consecutive SOT candidates who underwent DOT with 3HP for LTBI at Westchester Medical Center, Valhalla, New York, USA, between January 2013 and August 2016 were prospectively evaluated for tolerability and safety of 3HP. The diagnosis of LTBI was made in a person with a positive interferon-gamma release test, without a history of previously treated active or latent tuberculosis infection, and without signs, symptoms, or radiographic evidence of active tuberculosis. Patients were followed up 1 month after treatment completion and at routine follow-up visits with their transplant providers.
  
  
  RESULTS
  Eleven patients were men, and the median age was 60 years (range 44-72). Eight patients were liver, and four kidney transplant candidates. The median Model for End-Stage Liver Disease (MELD score) was 17 (range 10-31). All patients completed treatment. Only a single patient developed transaminitis greater than twice the baseline value. Three patients underwent liver transplantation. None of them developed tuberculosis at 9, 22, or 40 months following transplantation.
  
  
  CONCLUSIONS
  Directly observed 3HP LTBI treatment was not associated with hepatotoxicity, even in patients with higher MELD scores. Further studies are needed to confirm the safety and efficacy of this LTBI treatment regimen in the SOT population.
authors.affiliation: Transplant Infectious Diseases, Westchester Medical Center, 100 Woods Road, BHC-A-Wing LL, Valhalla, NY, 10595, USA. Bettina.Knoll@WMCHealth.org.|New York Medical College, Valhalla, NY, USA. Bettina.Knoll@WMCHealth.org.
authors.forename: B M
authors.initials: BM
authors.lastname: Knoll
authors.affiliation: Transplant Infectious Diseases, Westchester Medical Center, 100 Woods Road, BHC-A-Wing LL, Valhalla, NY, 10595, USA.|New York Medical College, Valhalla, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Nog
authors.affiliation: New York Medical College, Valhalla, NY, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Transplant Infectious Diseases, Westchester Medical Center, 100 Woods Road, BHC-A-Wing LL, Valhalla, NY, 10595, USA.|New York Medical College, Valhalla, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dhand
mesh_terms: D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D023801:Directly Observed Therapy / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009518:New York; D012293:Rifampin / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000904:Antibiotics, Antitubercular; D007538:Isoniazid; D012293:Rifampin; C018421:rifapentine
keywords: Isoniazid; Latent tuberculosis; Rifapentine; Solid organ transplantation