A Double-Blind Randomized Controlled Trial of Primary Isoniazid Prophylaxis in Dialysis and Transplant Patients

John, George; Thomas, P. P.; Thomas, Molly; Jeyaseelan, L.; Jacob, C. K.; Shastry, J. C. M.

doi:10.1097/00007890-199406150-00029

Cited by 26 publications

(40 citation statements)

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“…A significant incidence of hepatitis was reported in the study by John et al (29). Half of the patients who developed TB were actually ones who had been removed from INH ther-apy because of hepatitis, with hepatitis B virus infection in the most of them.…”

Section: Discussionmentioning

confidence: 91%

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Tuberculosis in Renal Transplant Recipients: The Evidence for Prophylaxis

Currie

Knight²,

Morris³

2010

Transplantation

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Both randomized and nonrandomized studies support the value of isoniazid as TB prophylaxis in renal transplant recipients at risk of active infection. Clinicians should consider prophylaxis in renal transplant recipients in endemic areas or in recipients in nonendemic countries who are at risk. However, the evidence for the benefit of isoniazid prophylaxis in renal transplantation is not robust and there is still a need for a large multicenter trial of isoniazid prophylaxis in kidney transplantation in an endemic area.

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Section: Discussionmentioning

confidence: 91%

“…John et al (29) in a study of primary INH prophylaxis in dialysis and renal transplant recipients in India found a trend toward lower incidence of TB in INH recipients. However, it did not reach statistical significance.…”

Section: Randomized Studiesmentioning

confidence: 98%

Tuberculosis in Renal Transplant Recipients: The Evidence for Prophylaxis

Currie

Knight²,

Morris³

2010

Transplantation

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“…The treatment of PPD‐positive patients with isoniazid after transplantation is also controversial 1 . This is due to the low prevalence of latent TB infections in the authors’ community, 5 conflicting results in prevention of reactivation, the lack of a defined treatment period 6 and the potential for increased hepatotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Miliary tuberculosis in a Caucasian male transplant recipient and the role of intravenous immunoglobulin as an immunosuppressive sparing agent (Case Report)

Lian¹,

Chan²,

Slavin

et al. 2006

Nephrology

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Opportunistic infections are a common and anticipated accompaniment of transplantation, but are generally somewhat predictable in their timing and epidemiology. The authors report here a case of miliary tuberculosis occurring within 3 weeks of transplantation, in a patient not expected to be significantly at risk, and with a normal chest X-ray at the time of transplantation. A 25-year-old Caucasian male dialysis patient who received two paediatric kidneys as an en bloc renal transplant developed fever 3 weeks following transplantation; this eventually proved to be miliary tuberculosis. As well as antituberculous therapy and a significant reduction in the patient's conventional immunosuppression, intravenous immunoglobulin was used as anti-rejection prophylaxis. The case highlights the immunosuppressed status of dialysis patients prior to transplantation and the need for broad differential diagnosis in transplant recipients even in the absence of recognized epidemiological factors. The case also emphasizes the role of intravenous immunoglobulin as an anti-rejection therapy that does not add to the patient's immunosuppressive burden.

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“…Randomized controlled trials carried out in India and Pakistan have evaluated the benefit of prophylactic treatment with isoniazid for KTRs. [19][20][21][22] Results of these studies suggest reduced risk of TB in patients who are treated with Isoniazid. However, these studies should be interpreted with caution as they are relatively small studies, open-labelled, with no placebo control and therefore are susceptible to bias, especially detection bias.…”

Section: Uncertainty Of Effectiveness Of Universal Anti-tb Prophylaximentioning

confidence: 97%

Peculiarities of tuberculosis in kidney transplant recipients

Adamu¹

2013

Ann Afr Med

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Renal transplant is becoming increasingly available in developing countries. Significant advances have been made globally since the first successful kidney transplant in 1954, with the advent of newer, more effective and more selective immunosuppressants. As a result, allograft and patient survival has increased, leaving infection and malignancy as major challenges. The incidence rate of tuberculsis in renal transplant recipients is directly proportional to the prevalence in the general population with the developing countries having the highest rates. The objective of this paper is to review the existing literature on post renal transplant tuberculosis with a view to highlighting its peculiarities compared to tuberculosis in the general population. Several databases (Medline, EMBASE, Cochrane data base, Google Scholar and AJOL) were searched for articles using the key words Tuberculosis (MESH), Renal (OR Kidney), AND transplant. Hand search was also made of reference list of retrieved articles. Full text of relevant original articles were retrieved and appraised. Several studies have demonstrated increased risk of tuberculosis in renal transplant recipients, especially in developing countries. Tuberculosis in renal transplant recipients has peculiarities such as difficulty in diagnosing latent TB, atypical presentations, increased risk of dissemination, increased mortality and interactions of anti-Tb drugs with transplant medications. Clinicians managing renal transplant recipients especially in developing countries should have a high index of suspicion for TB and be aware of its peculiarities in this patient population.

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A Double-Blind Randomized Controlled Trial of Primary Isoniazid Prophylaxis in Dialysis and Transplant Patients

Cited by 26 publications

References 0 publications

Tuberculosis in Renal Transplant Recipients: The Evidence for Prophylaxis

Tuberculosis in Renal Transplant Recipients: The Evidence for Prophylaxis

Miliary tuberculosis in a Caucasian male transplant recipient and the role of intravenous immunoglobulin as an immunosuppressive sparing agent (Case Report)

Peculiarities of tuberculosis in kidney transplant recipients

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