Korean J Transplant.  2022 Nov;36(Supple 1):S38. 10.4285/ATW2022.F-1413.

Safety and outcome of treatment of latent tuberculosis infection liver transplant recipients

Affiliations
  • 1Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Infectious Diseases, Chung-Ang University Hospital, Seoul, Korea
  • 3Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 4Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Background
There are limited data on the outcome and tolerability of latent tuberculosis infection (LTBI) treatment in liver trans-plant. We performed a retrospective cohort study of screening and treatment of LTBI in liver transplant (LT) patients.
Methods
All adult LT candidates at Asan Medical Center, a tertiary care teaching hospital in Seoul, Republic of Korea, from March 2020 to February 2022 were screened for LTBI. Patients with positive interferon-gamma releasing assay (IGRA) results or clinical risk factors for LTBI were treated, and the patients were planned to be followed for at least one year after transplantation.
Results
Of 899 LT patients, 199 (23%) were diagnosed with LTBI and deemed eligible for treatment (188 positive results for IGRA, nine abnormal chest radiography and no prior prophylaxis, one donor with active TB, three recent close contact with active TB). Of 199 patients, 171 (86%) initiated LTBI treatment and 28 (14%) did not receive treatment. Adequate LTBI treatment occurred in 142/171 (83%) patients; 109/142 (77%) completed, and 33/142 (23%) currently on LTBI treatment. LTBI treatment was discon-tinued prematurely in 29/171 (17%) patients. The most frequent reason reported was liver enzyme elevation (11/29, 38%). Nine months of isoniazid was the preferred regimen (133/142, 93.7%). Alternative regimens included isoniazid/rifampin (8/142, 5.6%), and quinolone (1/142, 0.7%). During the follow-up period, none of the LTBI-treated patient developed TB. Among 28 LTBI patients who did not receive treatment, 3.6% (1/28) developed TB. Among 658 patients without LTBI, 0.5% (3/658) developed TB.
Conclusions
Our study demonstrates that LTBI treatment in LT patients is effective for preventing active TB disease. Some pro-portion of LT recipients do not tolerate LTBI therapy, therefore treatment should be carried out with caution, especially for poten-tial hepatotoxicity.

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