Abad Cybele Lara R, Deziel Paul J, Razonable Raymund R
Section of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
Division of Infectious Diseases, Department of Medicine, The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA.
Transpl Infect Dis. 2019 Dec;21(6):e13178. doi: 10.1111/tid.13178. Epub 2019 Oct 1.
Mycobacterium tuberculosis disease may occur after treatment of latent TB infection (LTBI). Prompted by a case of reactivation TB disease in a solid organ transplant (SOT) recipient who received LTBI treatment, we reviewed the literature to examine outcomes, adverse effects, resistance, and treatment choices of tuberculosis after LTBI therapy.
MEDLINE and Web of Science from inception to 5/2019 were reviewed using key words "latent tuberculosis infection" and "SOT" or "transplantation." The search yielded nine cases, 41 cohort studies and six randomized controlled trials (RCT).
Cohort and RCT demonstrated significant reduction in TB disease among transplanted patients who received LTBI therapy; only 56/2651 (2.1%) SOT patients developed TB after LTBI therapy. Adverse drug reactions occurred in 149/1148 (12.9%) and 73/641 (11.4%) of cohort and RCT patients, respectively. Among liver recipients, 56/266 (21%) developed side effects, of which half (29/56, 51.8%) was INH-related. There was no reported INH resistance.
Latent TB infection treatment is efficacious in SOT recipients at risk of TB disease. However, tuberculosis may still occur despite LTBI treatment. Hepatotoxicity associated with LTBI therapy is infrequent, although more commonly observed among liver recipients.
潜伏性结核感染（LTBI）治疗后可能发生肺结核病。受一名接受LTBI治疗的实体器官移植（SOT）受者发生结核病复发病例的启发，我们查阅了文献，以研究LTBI治疗后结核病的转归、不良反应、耐药性及治疗选择。
检索MEDLINE和Web of Science数据库，检索时间从建库至2019年5月，关键词为“潜伏性结核感染”和“SOT”或“移植”。检索到9例病例、41项队列研究和6项随机对照试验（RCT）。
队列研究和RCT显示，接受LTBI治疗的移植患者中结核病显著减少；LTBI治疗后，只有56/2651（2.1%）的SOT患者发生结核病。队列研究和RCT患者中分别有149/1148（12.9%）和73/641（11.4%）发生药物不良反应。在肝移植受者中，56/266（21%）出现副作用，其中一半（29/56，51.8%）与异烟肼有关。未报告异烟肼耐药情况。
LTBI治疗对有结核病风险的SOT受者有效。然而，尽管进行了LTBI治疗，仍可能发生结核病。LTBI治疗相关的肝毒性不常见，尽管在肝移植受者中更常观察到。
