Introduction:

Screening and therapy of latent tuberculosis infection (LTBI) is recommended in transplant candidates. However, data on therapy of LTBI with fluoroquinolones are limited. We aimed to compare the safety and tolerability of various agents used for the treatment of LTBI.

Methods:

We performed a retrospective cohort study of adult transplant candidates or recipients diagnosed and treated for LTBI at a single transplant center in a low TB prevalence area from January 2001 to December 2016. The primary outcome was tolerability and rates of completion. Completion was defined as taking at least 90% of prescribed doses.

Results:

A cohort of 123 SOT candidates and recipients diagnosed with LTBI were identified and 110/123 (89.4%) of them were initiated on LTBI therapy. Of these, 24 were excluded since they were treated prior to listing and 86 were eligible for analysis. Transplant types were kidney (n=44), liver (n=16), lung (n=22), and other (n=4). Of this cohort, 59/86 (68.6%) were treated before transplant and 27/86 (31.4%) started therapy post-transplant (majority in post-transplant period (51.9%) were liver transplant recipients). First line therapy was Isoniazid (INH) in 67/86 (77.9%), Rifamycins in 12/86 (14.0%) and Quinolones were used in 7/86 (8.1%) mainly post liver transplant patients. The completion rate of INH was 52/67 (77%) , rifamycins 10/12 (83.3%) and quinolones 7/7 (100%) . Liver enzyme elevation was the main reason for non-completion in 10/67 (14.9%) on INH and 2/12 (16.7%) on rifamycins. Quinolones were used as second line in 5/9 (55.6%) of patients primarily in the post-transplant setting with 100% completion rate. Of all 95 first and second line treatment initiations, quinolones showed a trend towards greater completion rates than other agents (100% completion with quinolones vs. 79.5% with INH or rifamycins; p=0.08). No episodes of Clostridium difficile or quinolone-resistant infections were reported up to 1-year follow up for these patients from the time of treatment initiation. No cases of active tuberculosis occurred in any patient in this cohort.

Conclusion:

Completion of first-line therapy was suboptimal in our cohort of patients treated for LTBI. Most of the discontinuation occurred with INH therapy due to hepatotoxicity mainly in pre transplant setting. Quinolones were the preferred agents for liver transplant recipients and were well tolerated as first or second line agents.

CITATION INFORMATION: AlJishi Y., Bosaeed M., Husain S., Rotstein C., Humar A., Kumar D. Safety and Tolerability of Therapy for Latent Tuberculosis Infection: A 16-Year Review Am J Transplant. 2017;17 (suppl 3).

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