Purpose: Although isoniazid 300 mg daily for 9 months is the recommended regimen for latent tuberculosis infection (LTBI) in solid organ transplant (SOT) candidates, its use is controversial, due to reports of hepatotoxicity and low completion rates. The risk of hepatotoxicity is increased by hepatitis C virus (HCV) infection and elevated baseline transaminases, common in liver transplant candidates. A promising new regimen is a 12-week course of once weekly directly observed therapy with isoniazid 15 mg/kg plus rifapentine (32-50 kg, 750 mg; >50 kg, 900 mg) (3HP). We report our experience with 3HP LTBI treatment in kidney and liver transplant candidates.

Methods: Medical records of eight patients who underwent 3HP LTBI treatment at our center between January 2013 and April 2015 were reviewed. Data were censored in October 2015.

Results: The median age was 65 (range 55-72) years and 87.5% were men. Six patients were liver and two kidney transplant candidates. Five out of six liver transplant candidates had end-stage liver disease due to HCV infection. The median Model for End-stage Liver Disease (MELD) score was 21 (range 10-31). The overall dose compliance was 100%. All eight patients completed treatment without adverse effects. No patient developed transaminitis greater than twice the baseline value. Three patients underwent liver transplantation. None of them developed tuberculosis at 9, 13, or 31 months following transplantation.

Conclusion: Directly observed 3HP LTBI treatment was not associated with hepatotoxicity, even in patients with higher MELD scores, well tolerated, and had a high completion rate. Further studies are needed to confirm the safety and efficacy of this LTBI treatment regimen in the SOT population.

CITATION INFORMATION: Knoll B, Nog R, Wu Y, Dhand A. Three Months of Weekly Rifapentine Plus Isoniazid for Latent Tuberculosis Treatment in Solid Organ Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).

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