*Purpose: Even though guidelines recommend using isoniazid (INH) for TB prophylaxis depending on donors and recipients’ screening tests, previous studies supported its use in all transplant patients living in endemic areas regardless of their TB screening results. Therefore, this study aims to compare the effectiveness of using TB prophylaxis based on recipients TB screening tests versus using INH empirically in all lung transplant recipients.

*Methods: This was a retrospective cohort study of patients aged 13 years or above who underwent lung transplantation at King Faisal Specialist Hospital and Research Centre (KFSH & RC) in Riyadh, Saudi Arabia.Subjects were divided into two main groups. The First group, where INH was prescribed based on recipients’ or donor PPD or QuantiFERON screening tests. While, all subjects in the second group received INH regardless of the recipients’ or donors’ PPD or QuantiFERON results “Empiric TB prophylaxis”. Each patient was followed for 1 year after transplantation.

*Results: A total of 80 subjects were included.The majority (n=60) of the donors had unreported history of TB and none had a positive respiratory culture growing TB at baseline. Therefore, depending solely on recipients’ available data of TB screening testing, subjects were divided into 2 groups. Fifty subjects were in the screening-based prophylaxis group, only 7 (14%) of them received INH according to their positive screening test result. On the other hand, 30 subjects were in the empiric prophylaxis group, all subjects (n=30) received INH regardless of having a known negative TB test result or undetermined test results.Four patients (5%) developed respiratory TB infection during the first year of transplantation. All were on the screening-based prophylaxis group. Three of those 4 patients had unknown PPD test result and negative QuantiFERON, so they did not receive INH accordingly. The remaining patient grew TB despite being on INH. This patient was evident to have INH resistance..Most of the patients tolerated INH well. None of the patient experienced INH-induced hepatotoxicity.

*Conclusions: The effectiveness and safety of INH was demonstrated in this study supporting the use INH in all lung transplant recipients specially in endemic areas. Practitioners should weigh the benefit of INH preventing TB to its risks including INH side effects, drug interaction with IS and developing INH resistance.Regular monitoring of liver function test and educating the patient about reporting the hepatotoxicity symptoms is warrant for LT patients

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