Intervention Review

Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis

  1. Bappa Adamu1,*,
  2. Aliyu Abdu1,
  3. Abdullahi A Abba2,
  4. Musa M Borodo1,
  5. Imad M Tleyjeh3

Editorial Group: Cochrane Renal Group

Published Online: 4 MAR 2014

Assessed as up-to-date: 30 APR 2013

DOI: 10.1002/14651858.CD008597.pub2


How to Cite

Adamu B, Abdu A, Abba AA, Borodo MM, Tleyjeh IM. Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD008597. DOI: 10.1002/14651858.CD008597.pub2.

Author Information

  1. 1

    Aminu Kano Teaching Hospital, Department of Medicine, Kano, Kano, Nigeria

  2. 2

    King Saud University, Department of Medicine, Riyadh, Riyadh, Saudi Arabia

  3. 3

    King Fahad Medical City, Department of Medicine, Riyadh, Riyadh, Saudi Arabia

*Bappa Adamu, Department of Medicine, Aminu Kano Teaching Hospital, No 1 Hospital Road, Kano, Kano, PMB 3452, Nigeria. bappakano@yahoo.com.

Publication History

  1. Publication Status: New
  2. Published Online: 4 MAR 2014

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 淺顯易懂的口語結論

Background

Organ transplant recipients are at increased risk of infection as a result of immunosuppression caused inadvertently by medical treatment. Tuberculosis (TB) is a challenging infection to manage among organ transplant recipients that can be transmitted from infected people or triggered from latent infection. Organ transplant recipients have been reported to be up to 300 times more likely to develop TB than the general population. Consensus about the use of antibiotic prophylaxis to prevent post solid organ transplant TB has not been achieved.

Objectives

This review assessed the benefits and harms of antibiotic prophylaxis to prevent post solid organ transplant TB.

Search methods

We searched the Cochrane Renal Group's Specialised Register up to 30 April 2013 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE and handsearching conference proceedings.

Selection criteria

All randomised controlled trials (RCTs) and quasi-RCTs that compared antibiotic prophylaxis with a placebo or no intervention for recipients of solid organ transplants were included.

Data collection and analysis

Two authors independently assessed studies for inclusion and extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Methodological risk of bias was assessed using the Cochrane risk of bias tool.

Main results

We identified three studies (10 reports) that involved 558 kidney transplant recipients which met our inclusion criteria. All studies were conducted in countries that have high prevalence of TB (India and Pakistan), and investigated isoniazid, an oral antibacterial drug. Control in all studies was no antibiotic prophylaxis. Prophylactic administration of isoniazid reduced the risk of developing TB post-transplant (3 studies, RR 0.35 95% CI 0.14 to 0.89), and there was no significant effect on all-cause mortality (2 studies, RR 1.39, 95% CI 0.70 to 2.78). There was however substantial risk of liver damage (3 studies, RR 2.74, 95% CI 1.22 to 6.17).

Reporting of methodological quality parameters was incomplete in all three studies. Overall, risk of bias was assessed as suboptimal.

Authors' conclusions

Isoniazid prophylaxis for kidney transplant recipients reduced the risk of developing TB post-transplant. Kidney transplant recipients in settings that have high prevalence of TB should receive isoniazid during the first year following transplant. There is however, significant risk of liver damage, particularly among those who are hepatitis B or C positive. Further studies are needed among recipients of other solid organ transplants and in settings with low prevalence of TB to determine the benefits and harms of anti-TB prophylaxis in those populations.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 淺顯易懂的口語結論

Which drugs are most effective to prevent tuberculosis in organ transplant recipients?

Organ transplantation is often the best treatment option for patients with end-stage kidney, pancreas, heart, liver and lung disease. A major risk for transplant recipients is organ rejection. Although anti-rejection drugs improve survival, they weaken the immune system and increase the risk of infection, cancer, and cardiovascular disease.

Preventing and managing infection is a major challenge in organ transplant recipients. Tuberculosis (TB) is a particular concern because organ transplant recipients are up to 300 times more likely to contract this infection than people in the general population. TB can be difficult to diagnose because it can develop in different organs and body tissues aside from lungs.

We investigated whether drugs to prevent TB after transplant could reduce the disease in the post-transplant period. We found three studies that looked at 558 kidney transplant recipients in India and Pakistan where TB rates are high.

We found that taking the drug isoniazid (a tablet) during the first year after kidney transplant provided protection against developing TB. However, this drug also significantly increased the risk of liver damage. Most drug-related liver damage occurred in people who already had liver problems caused by hepatitis B or C. We also found that there was no difference in numbers of deaths from any cause between those who received the anti-TB drug and those who did not.

Although we found that isoniazid should be given to kidney transplant recipients in areas where TB is known to be a risk, further studies are needed in people who have received other organ transplants such as liver, lungs and heart, and where TB rates are low, to determine the wider benefits and harms of anti-TB drugs.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 淺顯易懂的口語結論

預防臟器移植後結核病之抗生素預防療法

背景

器官移植受贈者會因治療引發之無預期免疫抑制,導致感染風險增加。在器官移植受贈者治療上,結核病 (tuberculosis, TB) 是頗具挑戰性的感染症。結核病可經由已感染的患者傳染,或因潛伏性感染而觸發。曾有報告指出,器官移植受贈者罹患TB的機率,為一般群眾的300倍。醫學界對於使用抗生素預防療法來預防臟器移植後的TB,目前並未達成共識。

目的

本篇文獻回顧旨在評估使用抗生素預防療法,來預防臟器移植後TB的利弊得失。

搜尋策略

我們聯絡試驗搜尋協調員,使用與本文獻回顧有關的字彙,搜尋考科藍腎臟群組專業註冊 (Cochrane Renal Group's Specialised Register)截至2013年4月30日為止。透過專為CENTRAL、MEDLINE和EMBASE設計的搜尋策略,找出專業註冊所收錄的試驗,並以人工的方式搜尋研討會的會議記錄。

選擇標準

我們納入所有的隨機對照試驗(randomized controlled trial, RCT) 和半隨機對照試驗,研究對象為臟器移植受贈者,治療方法為抗生素預防療法、安慰劑或無任何治療介入。

資料收集與分析

由2位作者獨立評估試驗的納入資格和資料萃取。以風險比 (risk ratios, RR) 計算二元性資料,以平均差 (mean differences, MD) 計算連續資料,並報告95%信賴區間(confidence interval, CI)。利用考科藍偏差風險工具,評估方法學上的偏差風險。

主要結果

有3篇試驗 (10篇論文) 符合我們的納入條件,包含558名腎臟移植受贈者。所有的試驗都在TB盛行率偏高的國家 (印度和巴基斯坦) 進行,試驗藥物為口服抗生素isoniazid。所有試驗的對照組患者,均未接受抗生素預防療法。soniazid預防療法可降低移植術後的TB罹病風險 (3篇試驗,RR為0.35,95% CI為014至0.89),但對所有原因死亡 (all-cause mortality) 並無顯著影響 (2篇試驗,RR為1.39,95% CI為0.70至2.78)。不過肝臟受損的風險卻相當高 (3篇試驗,RR為2.74,95% CI為1.22至6.17)。

所有3篇試驗均未完整報告方法學的品質參數,整體的評估結果顯示,偏差風險未臻理想。

作者結論

使用isoniazid預防療法,可降低腎臟移植受贈者的術後TB罹病風險。在TB盛行率偏高的地區,腎臟移植受贈者應於接受移植後的第一年內,接受isoniazid預防治療。不過isoniazid治療具有明顯的肝臟損傷風險,尤其是B型肝炎或C型肝炎陽性的患者。未來必須針對其他臟器移植受贈者,以及TB盛行率偏低的地區進行研究,以判定這些族群接受抗TB預防療法的利與弊。

 

淺顯易懂的口語結論

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 淺顯易懂的口語結論

哪些藥物對器官移植受贈者的結核病預防效果最好?

晚期腎臟、胰臟、心臟、肝臟和肺臟疾病的患者而言,器官移植通常是最好的治療選擇。接受器官移植患者的主要風險為器官排斥。雖然抗排斥藥物可延長患者的存活期,但會減弱免疫系統的功能,並使患者罹患感染症、癌症和心血管疾病的風險增加。

預防和治療感染症是器官移植受贈者的重大挑戰,其中又以結核病 (TB) 特別值得關注,因為器官移植受贈者的結核病罹病風險,為一般族群的300倍。TB很難診斷,因為除了肺部以外,身體其他器官和組織也可能感染TB。

我們想研究使用預防性抗生素,是否能降低器官移植後的TB罹病率,結果找到3篇試驗。這些試驗以558名腎臟移植受贈者為對象,並在TB發生率很高的印度和巴基斯坦進行。

我們發現,在接受腎臟移植後第一年內服用isoniazid (錠劑),可保護患者避免罹患TB。不過這種藥物也會顯著提高肝臟受損的風險。大部分藥物引起的肝臟損傷,發生於已因B型肝炎或C型肝炎導致肝臟病變的患者。我們也發現,接受抗TB藥物和未接受抗TB藥物的患者,因任何原因死亡的人數並無差異。

雖然我們認為在已知有TB罹病風險的地區,腎臟移植受贈者應接受isoniazid治療,但未來必須針對接受其他器官移植的患者,例如肝臟、肺臟和心臟,以及TB發生率偏低的地區進行研究,才能判定抗TB藥物的普遍益處和傷害。

譯註


翻譯者:臺北醫學大學實證醫學研究中心
本翻譯計畫由衛生福利部補助經費,臺北醫學大學實證醫學研究中心、台灣實證醫學學會及東亞考科藍聯盟(EACA)統籌執行。