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Meta-Analysis
. 2014 Mar 4;2014(3):CD008597.
doi: 10.1002/14651858.CD008597.pub2.

Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis

Bappa Adamu  1 , Aliyu Abdu, Abdullahi A Abba, Musa M Borodo, Imad M Tleyjeh
Affiliations
Meta-Analysis

Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis

Bappa Adamu et al. Cochrane Database Syst Rev. .

Abstract

Background: Organ transplant recipients are at increased risk of infection as a result of immunosuppression caused inadvertently by medical treatment. Tuberculosis (TB) is a challenging infection to manage among organ transplant recipients that can be transmitted from infected people or triggered from latent infection. Organ transplant recipients have been reported to be up to 300 times more likely to develop TB than the general population. Consensus about the use of antibiotic prophylaxis to prevent post solid organ transplant TB has not been achieved.

Objectives: This review assessed the benefits and harms of antibiotic prophylaxis to prevent post solid organ transplant TB.

Search methods: We searched the Cochrane Renal Group's Specialised Register up to 30 April 2013 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE and handsearching conference proceedings.

Selection criteria: All randomised controlled trials (RCTs) and quasi-RCTs that compared antibiotic prophylaxis with a placebo or no intervention for recipients of solid organ transplants were included.

Data collection and analysis: Two authors independently assessed studies for inclusion and extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Methodological risk of bias was assessed using the Cochrane risk of bias tool.

Main results: We identified three studies (10 reports) that involved 558 kidney transplant recipients which met our inclusion criteria. All studies were conducted in countries that have high prevalence of TB (India and Pakistan), and investigated isoniazid, an oral antibacterial drug. Control in all studies was no antibiotic prophylaxis. Prophylactic administration of isoniazid reduced the risk of developing TB post-transplant (3 studies, RR 0.35 95% CI 0.14 to 0.89), and there was no significant effect on all-cause mortality (2 studies, RR 1.39, 95% CI 0.70 to 2.78). There was however substantial risk of liver damage (3 studies, RR 2.74, 95% CI 1.22 to 6.17).Reporting of methodological quality parameters was incomplete in all three studies. Overall, risk of bias was assessed as suboptimal.

Authors' conclusions: Isoniazid prophylaxis for kidney transplant recipients reduced the risk of developing TB post-transplant. Kidney transplant recipients in settings that have high prevalence of TB should receive isoniazid during the first year following transplant. There is however, significant risk of liver damage, particularly among those who are hepatitis B or C positive. Further studies are needed among recipients of other solid organ transplants and in settings with low prevalence of TB to determine the benefits and harms of anti-TB prophylaxis in those populations.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1 Isoniazid versus no treatment, Outcome 1 Tuberculosis.
1.2
1.2. Analysis
Comparison 1 Isoniazid versus no treatment, Outcome 2 All‐cause mortality.
1.3
1.3. Analysis
Comparison 1 Isoniazid versus no treatment, Outcome 3 Isoniazid hepatotoxicity.
1.4
1.4. Analysis
Comparison 1 Isoniazid versus no treatment, Outcome 4 Rejection episodes.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Agarwal 2004 {published data only}
    1. Agarwal SK, Gupta S, Dash SC, Bhowmik D, Tiwari SC. Prospective randomised trial of isoniazid prophylaxis in renal transplant recipient. International Urology & Nephrology 2004;36(3):425‐31. [MEDLINE: ] - PubMed
Naqvi 2010 {published data only}
    1. Akhtar S. Randomized controlled trial of isoniazid prophylaxis for tuberculosis in renal transplant patients [abstract]. Respirology 2009;14(Suppl 3):A143. [CENTRAL: CN‐00789394]
    1. Naqvi A, Hussain M, Nazvi R, Akhtar S, Akhtar F, Ahmed E, et al. Benefits of isoniazid chemoprophylaxis in renal transplant recipients [abstract no: 807]. Transplantation 2008;86(2S):281. [CENTRAL: CN‐00755654]
    1. Naqvi R, Akhtar S, Ahmed E, Akhtar F, Naqvi A, Rizvi A. Randomized trial of isoniazid chemoprophylaxis in renal transplant recipients in a highly prevalent region for tuberculosis [abstract no: SU‐PO583]. Journal of the American Society of Nephrology 2003;14(Nov):661A. [CENTRAL: CN‐00757829]
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    1. Naqvi R, Naqvi A, Akhtar S, Ahmed E, Noor H, Saeed T, et al. Use of isoniazid chemoprophylaxis in renal transplant recipients. Nephrology Dialysis Transplantation 2010;25(2):634‐7. [MEDLINE: ] - PubMed
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    1. Agarwal SK, Vikrant S, Dash SC, Gupta S, Tiwari SC, Guleria S, et al. Prospective randomised control trial of isoniazid prophylaxis during renal replacement therapy [abstract no: MP369]. Nephrology Dialysis Transplantation 2005;20(Suppl 5):v323. [CENTRAL: CN‐00757675]
    1. Vikrant S, Agarwal SK, Gupta S, Bhowmik D, Tiwari SC, Dash SC. Prospective randomised control trial of isoniazid (INH) chemoprophylaxis during renal replacement therapy [abstract]. Indian Journal of Nephrology 2002;12(4):171‐2. [CENTRAL: CN‐00461933]
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References to other published versions of this review

Adamu 2010
    1. Adamu B, Abdu A, Abba AA, Borodo MM, Tleyjeh IM. Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD008597] - DOI - PMC - PubMed

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