Prospective randomised trial of isoniazid prophylaxis in renal transplant recipient

被引：54
作者：
Agarwal S.K. [1 ]
Gupta S. [1 ]
Dash S.C. [1 ]
Bhowmik D. [1 ]
Tiwari S.C. [1 ]
机构：
[1] Department of Nephrology, AIIMS
来源：
International Urology and Nephrology | 2004年 / 36卷 / 3期
关键词：
INH prophylaxis; Renal transplant; Tuberculosis;
D O I：
10.1007/s11255-004-6251-6
中图分类号：
学科分类号：
摘要：
Renal transplantation (RT) recipients are at a high risk of developing tuberculosis (TB) following transplantation. Effectiveness of isoniazid (INH) in preventing TB is well documented in immunocompetent as well as immunocompromised persons. There is paucity of data on role of INH prophylaxis in RT recipients. Thus, a prospective randomised trial of INH in RT recipients was carried out to determine the efficacy of daily INH monotherapy in the prevention of TB in these patients. Patients of end stage renal disease (ESRD) taken for RT formed the subjects of study. Patients with active TB and active hepatitis at the time of RT were excluded from the study. Patients were randomised to receive INH 300 mg with pyridoxine 20 mg daily from the day of RT. The duration of the treatment was planned for 1 year or till the development of TB, which ever was earlier. Between October 1998 and September 2000, 114 RT were done at our hospital. Of these, 24 (21%) patients had active TB at the time of RT and thus were excluded. Patients included were randomised with 1:2 ratio of treatment and control group. Of the 90 patients thus enrolled, 30 were randomised in treatment group and 60 in control group. Of the included patients five patients had very early graft loss (three in treatment and two in control group) within days and thus excluded from the analysis. Three of the 27 (11.1%) patients in treatment group and 15 (25.8%) in control group developed TB (P = 0.10). The risk ratio of (RR) of INH versus control group of TB was 0.36 (95% CI, 0.10-1.32) but the difference was not statistically significant (P = 0.12). Only one patient developed INH induced hepatitis. In conclusion, with INH prophylaxis, there was a trend towards protection from TB, though it was not statistically significant. Further, all patients tolerated INH and hepatotoxicity was not a major problem in this group of patients. © 2004 Kluwer Academic Publishers.
引用
收藏
页码：425 / 431
页数：6
相关论文
共 29 条
  • [1] Targeted tuberculin testing and treatment of latent tuberculosis infection, Am. J. Respir. Crit. Care Med., 161, SUPPL., (2000)
  • [2] Drobniewski F.A., Ferguson J., Tuberculosis in renal transplant unit, Nephrol. Dial. Transplant., 11, pp. 768-770, (1996)
  • [3] Hussein M.M., Bakir N., Roujouleh H., Tuberculosis in patients undergoing maintenance dialysis, Nephrol. Dial. Transplant., 5, (1990)
  • [4] Singh N., Paterson D.L., Mycobacterium tuberculosis infection in solid-organ transplant recipients: Impact and implications for management, Clin. Infec.t Dis., 27, pp. 1266-1277, (1998)
  • [5] Naqvi A., Akhtar F., Naqvi R., Et al., Problems in diagnosis and treatment of tuberculosis in renal allograft recipients, Transplant Proc., 29, pp. 3051-3052, (1997)
  • [6] Malhortra K.K., Dash S.C., Dhawan I.K., Et al., Tuberculosis and renal transplantation-observations from an endemic area of tuberculosis, Post Grad. Med. J., 62, pp. 359-362, (1986)
  • [7] Agarwal S.K., Dash S.C., Tiwari S.C., Et al., Spectrum of tuberculosis in renal transplant recipients in North India, Ind. J. Nephrol., 12, pp. 39-43, (1992)
  • [8] Agarwal S.K., Tuberculosis in chronic renal failure, Tuberculosis, pp. 338-347, (2001)
  • [9] Sakhuja V., Jha V., Varma P.P., Et al., The high incidence of tuberculosis among renal transplant recipients in India, Transplantation, 61, pp. 211-215, (1996)
  • [10] Jha V., Sakhuja V., Gupta D., Et al., Successful management of pulmonary tuberculosis in renal allograft recipients in a single center, Kidney Int., 56, pp. 1944-1950, (1999)
123