Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis

Which drugs are most effective to prevent tuberculosis in organ transplant recipients?

Bappa Adamu1, Aliyu Abdu1, Abdullahi A Abba2, Musa M Borodo1, Imad M Tleyjeh3

Aminu Kano Teaching Hospital, Department of Medicine, Kano, Kano, Nigeria
King Saud University, Department of Medicine, Riyadh, Riyadh, Saudi Arabia
King Fahad Medical City, Department of Medicine, Riyadh, Riyadh, Saudi Arabia

Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD008597.

To read the full review please follow this link: DOI: 10.1002/14651858.CD008597.pub2.

Organ transplantation is often the best treatment option for patients with end-stage kidney, pancreas, heart, liver and lung disease. A major risk for transplant recipients is organ rejection. Although anti-rejection drugs improve survival, they weaken the immune system and increase the risk of infection, cancer, and cardiovascular disease.

Preventing and managing infection is a major challenge in organ transplant recipients. Tuberculosis (TB) is a particular concern because organ transplant recipients are up to 300 times more likely to contract this infection than people in the general population. TB can be difficult to diagnose because it can develop in different organs and body tissues aside from lungs.

We investigated whether drugs to prevent TB after transplant could reduce the disease in the post-transplant period. We found three studies that looked at 558 kidney transplant recipients in India and Pakistan where TB rates are high.

We found that taking the drug isoniazid (a tablet) during the first year after kidney transplant provided protection against developing TB. However, this drug also significantly increased the risk of liver damage. Most drug-related liver damage occurred in people who already had liver problems caused by hepatitis B or C. We also found that there was no difference in numbers of deaths from any cause between those who received the anti-TB drug and those who did not.

Although we found that isoniazid should be given to kidney transplant recipients in areas where TB is known to be a risk, further studies are needed in people who have received other organ transplants such as liver, lungs and heart, and where TB rates are low, to determine the wider benefits and harms of anti-TB drugs.