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.
Adamu, B.; Abdu, A.; Abba, A.A.; Borodo, M.M.; Tleyjeh, I.M. Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis. Cochrane Database of Systematic Reviews (2014) (Issue 3) Art. No.: CD008597. [DOI: 10.1002/14651858.CD008597.pub2]
Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis