Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3291
Peer-review started: February 20, 2019
First decision: April 30, 2019
Revised: May 30, 2019
Accepted: June 7, 2019
Article in press: June 7, 2019
Published online: July 14, 2019
Solid organ transplantation (SOT) is the best treatment option for end-stage organ disease. Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection, particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis. Active tuberculosis (TB) after SOT is a significant cause of morbidity and mortality. Most cases of posttransplant TB are secondary to reactivation of latent tuberculosis infection (LTBI) due to the effects of long-term immunosuppressive therapy. Risk minimization strategies have been developed to diagnose LTBI and initiate treatment prior to transplantation. Isoniazid with vitamin B6 supplementation is the treatment of choice. However, liver transplantation (LT) candidates and recipients have an increased risk of isoniazid-induced liver toxicity, leading to lower treatment completion rates than in other SOT populations. Fluoroquinolones (FQs) exhibit good in vitro antimycobacterial activity and a lower risk of drug-induced liver injury than isoniazid. In the present review, we highlight the disease burden posed by posttransplant TB and summarize the emerging clinical evidence supporting the use of FQs for the treatment of LTBI in LT recipients and candidates.
Core tip: Active tuberculosis after solid organ transplantation, particularly after liver transplantation, has a dismal outcome. This review focuses on the burden of active tuberculosis after liver transplantation and summarizes the most recent data concerning the use of isoniazid for the treatment of latent tuberculosis infection in liver transplant recipients and candidates. In addition, we review the most relevant clinical experience in the use of fluoroquinolones as an alternative approach with a favorable safety profile for the treatment of latent tuberculosis infection in the liver transplant setting.