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Latent TB Treatment Pre-Transplant Isoniazid — ESENeph MCQ

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ModerateTransplantationLatent TB Treatment Pre-Transplant IsoniazidESENeph

A 50-year-old man with ESKD is being assessed for transplantation. He had a positive tuberculin skin test (Mantoux 18 mm) during screening. Chest X-ray is normal. Interferon-gamma release assay (IGRA) is positive. He has no symptoms of active TB. He was born in a TB-endemic country. What is the recommended management before transplant listing?

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Correct answer: B — Treat with 6 months of isoniazid for latent TB before listing

In transplant candidates with evidence of latent TB infection (positive Mantoux AND positive IGRA, ruling out false-positive from BCG), treatment of latent TB before transplant is recommended to prevent reactivation under immunosuppression. Isoniazid 300 mg daily for 6 months (with pyridoxine) is the standard regimen. IGRA is more specific than Mantoux and is not affected by BCG vaccination. Rifampicin-based regimens (3-4 months) are an alternative but have significant drug interactions with calcineurin inhibitors post-transplant. Treatment should be completed before transplant listing, or at minimum before transplant surgery. LFTs should be monitored during isoniazid therapy.

Reference: NICE 2016 – NG33 Tuberculosis; BTS/UKKA 2018 – Transplant Screening Guidelines