Treatment of latent TB Infection and the risk of tuberculosis after solid organ transplantation: Comprehensive review

Cybele Lara R. Abad, Paul J. Deziel, Raymund R. Razonable

Research output: Contribution to journalReview article

Abstract

Background: Mycobacterium tuberculosis disease may occur after treatment of latent TB infection (LTBI). Prompted by a case of reactivation TB disease in a solid organ transplant (SOT) recipient who received LTBI treatment, we reviewed the literature to examine outcomes, adverse effects, resistance, and treatment choices of tuberculosis after LTBI therapy. Methods: MEDLINE and Web of Science from inception to 5/2019 were reviewed using key words “latent tuberculosis infection” and “SOT” or “transplantation.” The search yielded nine cases, 41 cohort studies and six randomized controlled trials (RCT). Results: Cohort and RCT demonstrated significant reduction in TB disease among transplanted patients who received LTBI therapy; only 56/2651 (2.1%) SOT patients developed TB after LTBI therapy. Adverse drug reactions occurred in 149/1148 (12.9%) and 73/641 (11.4%) of cohort and RCT patients, respectively. Among liver recipients, 56/266 (21%) developed side effects, of which half (29/56, 51.8%) was INH-related. There was no reported INH resistance. Conclusions: Latent TB infection treatment is efficacious in SOT recipients at risk of TB disease. However, tuberculosis may still occur despite LTBI treatment. Hepatotoxicity associated with LTBI therapy is infrequent, although more commonly observed among liver recipients.

Original languageEnglish (US)
Article numbere13178
JournalTransplant Infectious Disease
DOIs
StateAccepted/In press - Jan 1 2019

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Organ Transplantation
Tuberculosis
Infection
Latent Tuberculosis
Transplants
Therapeutics
Randomized Controlled Trials
Liver
Drug-Related Side Effects and Adverse Reactions
Mycobacterium tuberculosis
MEDLINE
Cohort Studies

Keywords

  • latent TB
  • Mycobacterium tuberculosis
  • solid organ transplant

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

Cite this

Treatment of latent TB Infection and the risk of tuberculosis after solid organ transplantation : Comprehensive review. / Abad, Cybele Lara R.; Deziel, Paul J.; Razonable, Raymund R.

In: Transplant Infectious Disease, 01.01.2019.

Research output: Contribution to journalReview article

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abstract = "Background: Mycobacterium tuberculosis disease may occur after treatment of latent TB infection (LTBI). Prompted by a case of reactivation TB disease in a solid organ transplant (SOT) recipient who received LTBI treatment, we reviewed the literature to examine outcomes, adverse effects, resistance, and treatment choices of tuberculosis after LTBI therapy. Methods: MEDLINE and Web of Science from inception to 5/2019 were reviewed using key words “latent tuberculosis infection” and “SOT” or “transplantation.” The search yielded nine cases, 41 cohort studies and six randomized controlled trials (RCT). Results: Cohort and RCT demonstrated significant reduction in TB disease among transplanted patients who received LTBI therapy; only 56/2651 (2.1{\%}) SOT patients developed TB after LTBI therapy. Adverse drug reactions occurred in 149/1148 (12.9{\%}) and 73/641 (11.4{\%}) of cohort and RCT patients, respectively. Among liver recipients, 56/266 (21{\%}) developed side effects, of which half (29/56, 51.8{\%}) was INH-related. There was no reported INH resistance. Conclusions: Latent TB infection treatment is efficacious in SOT recipients at risk of TB disease. However, tuberculosis may still occur despite LTBI treatment. Hepatotoxicity associated with LTBI therapy is infrequent, although more commonly observed among liver recipients.",
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