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Safety and outcome of treatment of latent tuberculosis infection in liver transplant recipients

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Abstract

Purpose

Liver transplant (LT) recipients have an increased risk of tuberculosis (TB), which is associated with higher mortality rates. This retrospective cohort study assessed the outcome and tolerability of screening and treatment of latent tuberculosis infection (LTBI) in LT recipients.

Methods

Between March 2020 and February 2022, all adult LT candidates at our institution were screened for LTBI. The candidates who tested positive for interferon-γ-releasing assay or met epidemiological or clinical-radiological criteria for LTBI were treated and monitored.

Results

Among the 857 LT recipients, 199 (23.2%) were diagnosed with LTBI, of which 171 (85.9%) initiated LTBI treatment. The median duration of follow-up was 677 days. Adequate LTBI treatment occurred in 141/171 (82.5%) patients and was discontinued prematurely in 30/171 (17.5%) patients. The most common reason for discontinuation was liver enzyme elevation (11/30, 36.7%), although only five discontinued treatment due to suspicion of isoniazid-associated hepatotoxicity. None of the LTBI-treated patients developed active TB during the follow-up period, while 3.6% (1/28) of untreated LTBI patients and 0.6% (4/658) of patients without LTBI developed TB.

Conclusion

These findings demonstrate that LTBI screening and treatment is a safe and effective strategy to prevent TB in LT recipients. However, monitoring for adverse events and liver enzyme elevation is recommended.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

LT:

Liver transplant

TB:

Tuberculosis

LTBI:

Latent tuberculosis infection

SOT:

Solid organ transplantation

IGRA:

Interferon-γ-releasing assay

ID:

Infectious disease

IQR:

Interquartile range

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Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea

    Yun Woo Lee

  2. Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea

    Hyemin Chung

  3. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Sung-Han Kim & Sang-Oh Lee

  4. Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Heungsup Sung

  5. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Su-Min Ha, Eun-Kyoung Jwa, Dong-Hwan Jung, Deok-Bog Moon & Sung-Gyu Lee

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Contributions

Conceptualization: S-OL; Data acquisition: HC, HS, S-MH, E-KJ, D-HJ, D-BM, Data analysis and interpretation: YWL, S-OL, S-HK, HS; Supervision: S-GL, S-HK, D-HJ, D-BM; Visualization: YWL, S-OL; Writing—Original draft: YWL; Writing—Review and editing: S-OL. All authors approved the manuscript.

Corresponding author

Correspondence to Sang-Oh Lee.

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The authors of this manuscript have no conflicts of interest or financial ties to disclose.

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Lee, Y.W., Chung, H., Kim, SH. et al. Safety and outcome of treatment of latent tuberculosis infection in liver transplant recipients. Infection (2024). https://doi.org/10.1007/s15010-023-02161-1

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