Efficacy and safety of a preventive strategy against tuberculosis in liver transplantation recipients including the treatment of latent infection with moxifloxacin.

IF 2.6 4区医学 Q3 IMMUNOLOGY Transplant Infectious Disease Pub Date : 2024-09-28 DOI:10.1111/tid.14382

Marina Fayos, Jose Tiago Silva, Mario Fernández-Ruiz, Tamara Ruiz-Merlo, Alessandro Visentin, Carmelo Loinaz, Alejandro Manrique-Municio, José María Caso, Jesús González-Olmedo, Isabel Rodríguez-Góncer, Francisco López-Medrano, Carlos Lumbreras, José María Aguado, Rafael San-Juan

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Abstract

Background: Preventive management of tuberculosis in liver transplantation (LT) is challenging due to difficulties in detecting and treating latent tuberculosis infection (LTBI). The aim of this study was to analyze the safety and efficacy of a screening strategy for LTBI with the inclusion of moxifloxacin as treatment.

Methods: We performed a retrospective single-center study of all LTs performed between 2016 and 2019 with a minimum 4-year follow-up and a standardized protocol for the evaluation of LTBI.

Results: Pretransplant LTBI screening was performed in 191/218 (87.6%) patients, and LTBI was diagnosed in 27.2% of them. Treatment for LTBI was administered to 71.2% of the patients and included moxifloxacin in 75.6% of the cases. After a median follow-up of 1628 days, no cases of active tuberculosis occurred among moxifloxacin-treated patients. The incidence of Clostridioides difficile (0.46 vs. 0.38 episodes/1000 transplant-days; p = .8) and multidrug-resistant gram-negative bacilli infection (0 vs. 0.7 episodes per 1000 transplant-days; p = .08) were not significantly higher in comparison to patients who did not receive moxifloxacin.

Conclusion: A preventive strategy based on systematic LTBI screening and moxifloxacin treatment before LT in positive cases appears safe and effective in preventing the development of tuberculosis in LT recipients. However, our findings are limited by a small sample size; thus, larger studies are required to validate our observations.

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肝移植受者结核病预防策略的有效性和安全性，包括使用莫西沙星治疗潜伏感染。

背景：由于难以检测和治疗潜伏结核感染（LTBI），肝移植（LT）中结核病的预防管理具有挑战性。本研究旨在分析将莫西沙星作为治疗药物的 LTBI 筛查策略的安全性和有效性：我们对2016年至2019年期间进行的所有LT进行了单中心回顾性研究，随访至少4年，并采用标准化方案评估LTBI：191/218（87.6%）名患者进行了移植前LTBI筛查，其中27.2%的患者确诊为LTBI。71.2%的患者接受了LTBI治疗，其中75.6%的患者接受了莫西沙星治疗。经过中位 1628 天的随访，接受过莫西沙星治疗的患者中没有出现活动性肺结核病例。与未接受莫西沙星治疗的患者相比，艰难梭菌感染（0.46 vs. 0.38次/1000移植日；p = .8）和耐多药革兰氏阴性杆菌感染（0 vs. 0.7次/1000移植日；p = .08）的发病率并无明显增加：结论：基于系统性LTBI筛查和在LT前对阳性病例进行莫西沙星治疗的预防策略在预防LT受者发生结核病方面似乎是安全有效的。然而，我们的研究结果受到样本量较小的限制；因此，需要更大规模的研究来验证我们的观察结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.