Kidney Week

Abstract: FR-PO914

Clinical Experience of Prevalence and Prophylaxis for Latent Tuberculosis Infection in Living Donor Kidney Transplant Recipients

Session Information

• Transplantation: Translational and Transplant Pathology
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Ban, Tae Hyun, Seoul St. Mary's hospital, Seoul, SEOUL, Korea (the Republic of)

Tae Hyun Ban,

• Chung, Byung ha, Seoul St. Mary's Hospital, Seoul, Korea (the Republic of)

Byung ha Chung,

• Choi, Bumsoon, Division of Nephrology, Department of Internal Medicine, Seoul, Korea (the Republic of)

Bumsoon Choi,

• Park, Cheol Whee, The Catholic University of Korea, Seoul, Korea (the Republic of)

Cheol Whee Park,

• Kim, Yong-Soo, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)

Yong-Soo Kim,

• Yang, Chul Woo, Seoul St. Mary's Hospital, Seoul, Korea (the Republic of)

Chul Woo Yang,

Background

Latent tuberculosis infection (LTBI) is a risk factor of active tuberculosis (TB) in kidney transplant recipients (KTRs). Transplant-associated TB poses a significant risk for both graft loss and patient death. Current guideline recommends LTBI prophylaxis in KTRs. The aim of this study was to assess the property of current LTBI prophylaxis.

Methods

We investigated 404 living donor KTRs between November 2013 and December 2017. We analyzed Data including QFT, TST, chest radiography, past TB history, post-transplant TB incidence, and current practice of LTBI prophylaxis. LTBI was diagnosed to one of following criteria: (1) positive result in tuberculin skin test (TST) or interferon-gamma release assays (IGRA) by QuantiFERON-TB Gold In-Tube test (QFT); (2) the old healed TB sequelae in chest radiography without TB treatment history; (3) previously insufficient TB treatment history; (4) contact history with active pulmonary TB patient within a year. Initial prophylactic agent for LTBI was isoniazid 300mg per day.

Results

The mean follow-up period of the patients 25.6 ± 14.2 months. QFT was positive in 37.6% (n=152), while TST was only positive in 13.1% (n=30). Additionally, only seven patients (1.7%) among patients with negative QFT were positive TST. On the other hand, there was no tuberculosis outbreak in living donor kidney transplant recipients during followed-up period. A total of 137 subjects were prescribed INH. Of them, 37 patients (27%) underwent adverse events, with the most common adverse event being hepatotoxicity, most occurring within three months.

Conclusion

Careful surveillance in KTRs needs at early period of INH prophylaxis. High incidence of adverse events of INH prophylaxis including hepatotoxicity suggests to need additional strategies to reduce that in LTBI prophylaxis.