Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis.
Adamu B, Abdu A, et al.Cochrane Database of Systematic Reviews 3: CD008597 2014
Aims
This systematic review aims to evaluate the benefits and harms of antibiotic prophylaxis to prevent tuberculosis (TB) in solid organ transplant recipients.
Interventions
Interventions included antituberculous antibiotic (isoniazid) versus placebo or no treatment.
Participants
All solid organ transplant recipients.
Outcomes
The primary outcome was the occurrence of Tuberculosis in kidney transplant recipients. The secondary outcomes included acute allograft rejection, chronic allograft rejection, calcineurin toxicity, unclassified allograft dysfunction, kidney function measures, hepatitis, hospital admissions, withdrawal from treatment, mortality and other adverse events as reported by primary authors of randomised controlled trials or quasi-RCTs.
Follow-up
N/A
CET Conclusions
This was a Cochrane systematic review of the use of isoniazid in kidney transplant recipients to prevent the development of tuberculosis. Three studies were used and these included 558 patients. There was less tuberculosis but more hepatic toxicity in the patients who received prophylaxis with isoniazid. The studies included were of poor quality but on the basis of their observations the authors recommend prophylaxis with isoniazid for one year in patients at risk of developing TB,.as this reduces the risk of developing TB post-transplant but there is a significant risk of liver damage. Does this systematic review add anything to the more comprehensive systematic review by Currie, AC and colleagues published in 2010 (Currie, AC, Knight SR and Morris PJ. Transplantation 2010 90:695-704). The answer is no,but Currie and colleagues felt that there was a need still for a larger multicentre trial of isoniazid prophylaxis in kidney transplantation in an endemic area. They also pointed out that the risk of hepatotoxicity was confined mainly to those patients with Hepatitis B or C infection.
Quality notes
This is a systematic review - quality assessment is not appropriate
Trial registration
Not reported.