Naqvi R, Akhtar S, Noor H, Saeed T, Bhatti S, Sheikh R, Ahmed E, Akhtar F, Naqvi A, Rizvi A
Sindh Institute of Urology and Transplantation (SIUT), Civil Hospital, Karachi 74200, Pakistan.
Transplant Proc. 2006 Sep;38(7):2057-8. doi: 10.1016/j.transproceed.2006.06.010.
The efficacy of isoniazid (INH) prophylaxis in renal allograft recipients who are on long-term immunosuppression in a region highly prevalent for tuberculosis (TB) was studied. INH (300 mg/d in patients weighing more than 35 kg and 5 mg/kg/d in patients with <35 kg body weight) together with Pyridoxine 50 mg/d for 1 year was started in randomly assigned renal allograft recipients. Occurrence of clinical tuberculosis during the initial 2 years posttransplantation was observed in the risk group and patients at no risk. Risks were defined as acute rejection episodes and exposure to antirejection therapy, past history of TB completely or incompletely treated, radiological evidence of past tuberculosis, history of tuberculosis in close contacts. Among 480 patients registered in the study, INH prophylaxis was given to 219 randomly assigned renal allograft recipients. Results were compared among patients developing TB during the initial 2 years posttransplantation in both the groups. Risk factors were analyzed for comparison in both groups. No significant difference was observed in terms of past history of TB, TB in close contacts, episodes of acute rejection during the initial 3 months, and comorbidities such as cytomegalovirus infection, hepatitis C virus infection, and posttransplant diabetes. One patient from the INH group and 10 patients from the non-INH group developed TB during the initial 2 years posttransplantation (P < .0001). None of patients required discontinuation of INH. INH was observed to be safe and effective as a chemoprophylactic agent in renal allograft recipients.
在结核病（TB）高度流行地区，对长期接受免疫抑制治疗的肾移植受者进行异烟肼（INH）预防治疗的疗效进行了研究。随机分配的肾移植受者开始服用INH（体重超过35 kg的患者每日300 mg，体重<35 kg的患者每日5 mg/kg）加维生素B6每日50 mg，持续1年。观察风险组和无风险患者在移植后最初2年内临床结核病的发生情况。风险定义为急性排斥反应发作和接受抗排斥治疗、既往有完全或不完全治疗的结核病病史、既往结核病的影像学证据、密切接触者有结核病病史。在该研究登记的480例患者中，219例随机分配的肾移植受者接受了INH预防治疗。比较两组在移植后最初2年内发生结核病的患者的结果。分析两组的风险因素以进行比较。在既往结核病病史、密切接触者中有结核病、最初3个月内的急性排斥反应发作以及合并症如巨细胞病毒感染、丙型肝炎病毒感染和移植后糖尿病方面，未观察到显著差异。INH组有1例患者和非INH组有10例患者在移植后最初2年内发生了结核病（P<0.0001）。没有患者需要停用INH。在肾移植受者中，INH作为化学预防剂被观察到是安全有效的。
