Experience With Moxifloxacin For The Treatment Of Latent Tuberculosis Infection In Liver Transplantation: A Single-Center Prospective Study

Active tuberculosis (TB) after liver transplantation (LT) is associated with poor outcomes. Most cases arise from the reactivation of latent tuberculosis infection (LTBI). Current guidelines recommend LTBI treatment for all LT candidates with compensated cirrhosis, with isoniazid plus pyridoxine as the preferred regimen. Nevertheless, both completion rates and tolerability are low. Fluoroquinolones exhibit good antimycobacterial activity and favorable safety profile. We report our single-center experience with a 9-month moxifloxacin regimen (400 mg daily) for the treatment of LTBI in the LT setting. Between 2015 and 2019, 28 candidates and 10 recipients received moxifloxacin for a median of 260 days (interquartile range: 180 - 274). The 9-month course was completed in 60.5% (23/38) of patients. Adverse events (AEs) requiring permanent treatment discontinuation occurred in 21.0% (8/38) of patients (Clostridioides difficile infection [5 cases], diffuse arthralgias [2 cases], and hematologic toxicity [one case]). All AEs resolved without sequelae, with no episodes of moxifloxacin-associated liver toxicity. No cases of active TB were diagnosed following completion of therapy (cumulative follow-up of 19,475 patient-days). In conclusion, a 9-month moxifloxacin regimen appears to be a reasonable alternative to isoniazid for the treatment of LTBI among LT candidates and recipients, although a close follow-up is mandatory for an early recognition of associated AEs.