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Latent TB Treatment Pre-Transplant — ESENeph MCQ

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ModerateTransplantationLatent TB Treatment Pre-TransplantESENeph

A 60-year-old man with CKD G5D on HD has a positive tuberculin skin test (Mantoux 20 mm) but no symptoms or CXR abnormality. He is being listed for transplant. What is the recommended approach to latent TB?

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Correct answer: D — Treat latent TB before transplantation – Isoniazid 300 mg daily for 6-9 months (with Pyridoxine) or Rifampicin-based short course; latent TB can reactivate under post-transplant immunosuppression

KDIGO 2020 transplant candidate guideline recommends screening for and treating latent TB before transplantation. Post-transplant immunosuppression significantly increases TB reactivation risk. Isoniazid 300 mg daily for 6-9 months (with Pyridoxine 10 mg to prevent neuropathy) is the standard regimen. Alternative short-course regimens include Rifampicin 4 months or Isoniazid/Rifapentine 3 months. In CKD, Isoniazid does not require dose adjustment but hepatotoxicity monitoring (LFTs) is needed. Note that Rifampicin has major drug interactions with Tacrolimus and Ciclosporin (CYP3A4 induction) and should be avoided in the peri-transplant period.

Reference: KDIGO 2020 – Transplant Candidate; NICE NG33 2019 – TB