Introduction: Active Tuberculosis (TB) is common post solid organ transplantation (SOT). Incidence post SOT in Europe is reported to be between 0.7–5%. Isoniazid (INH) is commonly used for chemoprophylaxis (CP) in high risk patients post SOT with significant variation in dose and duration between transplant centres in UK. The aim of this study is to determine the incidence of TB post Kidney (KT) and Kidney Pancreas (KPT) transplantation in our centre where we use INH 150mg daily together with Pydridoxine 50mg weekly as CP in high risk patients.

Methods: In this retrospective single centre study, the largest of its kind in UK, all lab-confirmed cases of TB were identified from the records of KT and KPT patients in our centre between Nov 2005 and Nov 2014 with follow up until Nov 2015. All patients received a steroid sparing, Tacrolimus based maintenance regimen with monoclonal antibody induction. Patients with previous TB or at high risk due to ethnic or geographical background received TB CP with INH 150mg daily and Pyridoxine 50mg weekly whilst they remain on immunosuppression. Patients intolerant of INH received Moxifloxacin 400mg daily.

Results: Total of 1424 patients were included (518F and 906M), mean age was 54.6 years (range 21-83 years) and mean follow up was 5.5 years (range 1-10 years). 47.2% were Caucasian, 30.7% were Asians and 11.2% were Afro-Caribbean. Total of 3 cases of definite active TB were identified. These were MTB isolated from lymph nodes. There was 1 case of a NMTB isolated from early morning sputum sample but treated empirically for MTB. 2 patients were of south Asians origin and 2 were of other ethnicity. 3 out of the 4 patients were on TB CP. All 3 MTB showed resistance (2 to INH and 1 to Moxifloxacin and Pyrazinamide). 2 of the MTB cases were detected early within first 7 months post transplantation. The other 2 cases were detected at 49 and 93 months post transplantation. It was unclear if INH resistance was associated with low dose INH used or whether this was primary infection with a resistant strain.

Conclusion: long-term TB CP using low dose INH of 150mg daily was associated with a very low rate of TB in a multi-ethnic group of patients in our centre. Further studies are needed to evaluate if INH resistance can be avoided with a standard dose of INH and if shorter courses are similarly adequate.

CITATION INFORMATION: Al-Mula Abed Y, Charif R, Kon O, Taube D. TB Chemoprophylaxis Post Transplantation in West London. Am J Transplant. 2017;17 (suppl 3).

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