Transplant Trial Watch

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

Abad, C. L. R., et al.

Transplant Infectious Disease 2019; 21(6): e13178.


Aims
The aim of this study was to evaluate the effects of latent tuberculosis infection (LTBI) therapy in solid organ transplant recipients.

Interventions
Two electronic databases including MEDLINE and Web of Science were searched from inception to May 2019.

Participants
57 studies (10 case reports, 41 cohort studies and 6 randomized controlled trials) were included in the review.

Outcomes
The outcomes of interest were the active tuberculosis infection rate, the risk of resistance, the occurrence of adverse effects and the treatment choices of active tuberculosis following LTBI therapy.

Follow-up
N/A

CET Conclusions
The comprehensive systematic review aimed to review the literature of mycobacterium tuberculosis (TB) among adult solid organ transplantation recipients who developed active disease after treatment for latent TB infection (LTBI). Medline and Web of Science were searched using keywords but no further information was provided about the screening and data extraction process. The review identified six randomised controlled trials (RCTs) and 41 cohort studies that evaluated outcomes after LTBI therapy. Isoniazid (INH) prophylaxis was the most common drug regimen. Patients receiving LTBI prophylaxis were less likely to develop active TB, although the overall incidence of developing TB disease in patients treated for LTBI was low (approximately 2%). The literature search also identified nine detailed descriptions of cases of active TB disease after LTBI treatment. All cases were born in TB-endemic regions. TB disease occurred after a median of 10 (2‐96) months after transplantation and most cases received INH as LTBI therapy. The authors conclude that TB disease may still occur after treatment of LTBI and they recommend LTBI treatment for transplant candidates and recipients.

Trial registration
N/A

Funding source
Not reported