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05 June 2017 : Original article  

Isoniazid Prophylaxis for Latent Tuberculosis Infections in Liver Transplant Recipients in a Tuberculosis-Endemic Area

Hyung Hwan Moon1BCDE, So Yeon Park2CD, Jong Man Kim3E, Jae Berm Park3E, Choon Hyuck David Kwon3E, Kyong Ran Peck4F, Sung-Joo Kim3A, Suk-Koo Lee5A, Jae-Won Joh3A*

DOI: 10.12659/AOT.902989

Ann Transplant 2017; 22:338-345

Abstract

BACKGROUND: Isoniazid (INH) prophylaxis (Px) has good efficacy for preventing tuberculosis (TB) in the general population. However, its use for the treatment of latent TB infections (LTBI) in liver transplant (LT) recipients is challenging because little is known about INH-induced hepatotoxicity in graft recipients. We evaluated the efficacy and safety of INH Px in LT recipients.

MATERIAL AND METHODS: From March 2008 to December 2012, we retrospectively reviewed data on 277 patients who received LT at a single center. We examined the results of tuberculin skin tests and interferon-γ release assays, use of INH, INH-induced hepatotoxicity, and post-LT TB occurrence.

RESULTS: Among 277 recipients, 7 cases of post-transplant TB were detected (2.52%). Seventeen patients received post-transplant INH Px. Among INH Px recipients, post-LT TB infection did not occur. Hepatotoxicity after INH Px was significantly lower in the patients who received INH Px at an aspartate aminotransferase (AST) level that was less than 50 U/L than in those who received INH Px at an AST level that was more than 50 U/L (P=0.046, 0.002).

CONCLUSIONS: INH is likely to be effective for preventing post-LT TB recurrence in LTBI. However, because of INH-induced hepatotoxicity, it is better to avoid using it in the early post-LT period and to wait to initiate INH Px until liver function is stable in LT recipients.

Keywords: Isoniazid, latent tuberculosis, Liver Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358