Antony S J, Ynares C, Dummer J S
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
Clin Transplant. 1997 Feb;11(1):34-7.
Tuberculosis occurs at higher rates in renal transplant recipients than in the general population. It would be desirable to use isoniazid prophylaxis in renal transplant recipients at risk for reactivation of tuberculosis; yet many transplant centers do not routinely employ INH prophylaxis because they perceive transplant recipients to be an enhanced risk of hepatotoxicity from isoniazid. Data on the risk of isoniazid in renal transplant patients receiving cyclosporine-based immunosuppression are limited. We retrospectively studied 83 renal transplant recipients (mean age 39.1 +/- 11.7 yr) who had received INH prophylaxis between 1985 and 1994. Eight patients had laboratory evidence of chronic hepatitis B or chronic hepatitis C infection. The mean duration of INH therapy was 344 +/- 163 d. The mean serum glutamate oxalacetic transferase (SGOT) at the start of INH therapy was 24.1 +/- 10.9 I.U., and 10% of patients had mildly elevated SGOTs. Mean peak SGOT during therapy was 36.4 +/- 15.3 I.U. (p < 0.001 compared to start (SGOT). In follow up, 31% of patients had an abnormal SGOT (> 40 I.U.); however, the elevations were small (the highest SGOT was 88.I.U.) and never necessitated discontinuation of INH. No patient had jaundice or other evidence of clinical hepatotoxicity. The 95% confidence interval for the observed frequency of clinical hepatitis was 0% to 4.3%. At the end of INH therapy the mean SGOT was 22.7 +/- 6.2 I.U. (p > 0.2, compared with start SGOT) and only one patient had an abnormal SGOT. In conclusion, it appears that the risk of renal transplant recipients developing serious hepatotoxicity with the administration of INH is low and not different from normal individuals.
肾移植受者中结核病的发生率高于普通人群。对于有结核病复发风险的肾移植受者，使用异烟肼进行预防是可取的；然而，许多移植中心并不常规采用异烟肼预防措施，因为他们认为移植受者因异烟肼导致肝毒性的风险更高。关于接受基于环孢素的免疫抑制治疗的肾移植患者使用异烟肼的风险数据有限。我们回顾性研究了1985年至1994年间接受异烟肼预防治疗的83例肾移植受者（平均年龄39.1±11.7岁）。8例患者有慢性乙型肝炎或慢性丙型肝炎感染的实验室证据。异烟肼治疗的平均持续时间为344±163天。异烟肼治疗开始时血清谷氨酸草酰乙酸转氨酶（SGOT）的平均值为24.1±10.9国际单位，10%的患者SGOT轻度升高。治疗期间SGOT的平均峰值为36.4±15.3国际单位（与开始时的SGOT相比，p<0.001）。在随访中，31%的患者SGOT异常（>40国际单位）；然而，升高幅度较小（最高SGOT为88国际单位），从未需要停用异烟肼。没有患者出现黄疸或其他临床肝毒性证据。观察到的临床肝炎发生频率的95%置信区间为0%至4.3%。异烟肼治疗结束时，SGOT的平均值为22.7±6.2国际单位（与开始时的SGOT相比，p>0.2），只有1例患者SGOT异常。总之，肾移植受者使用异烟肼发生严重肝毒性的风险似乎较低，与正常个体无异。
