Comparison of Rifampin and Isoniazid for Latent Tuberculosis Infection in Kidney Transplant Candidates: Focus on Tolerability and Treatment Completion

Background A 4-month course of rifampin is one of the recommended first-line regimens for latent tuberculosis infection (LTBI). However, data on its use among kidney transplant candidates (KTC) remain limited. Methods We conducted a retrospective study of all KTC treated with either 4-month rifampin or 9-month isoniazid (INH) for LTBI at a transplant infectious disease clinic in Miami from January 1, 2021 to December 31, 2024. We assessed rates of treatment completion, adverse reactions leading to discontinuation of therapy, and transaminase elevation (> 2 times the upper limit of normal). The potential impact of rifampin on blood pressure (BP) in patients on antihypertensive drugs (AHD) known to interact with rifampin was also evaluated. Results A total of 66 patients were analyzed (49 [74%] in the INH group and 17 [26%] in the rifampin group). There was a trend towards higher treatment completion in the rifampin group compared to the INH group (16 [94%] vs. 34 [69%], p = 0.05). There was no difference in adverse reactions leading to treatment discontinuation. Transaminase elevations were not observed in the rifampin group, whereas they occurred in 3 (6%) of the INH group. Three patients experienced an increase in BP while receiving rifampin, leading to treatment discontinuation in one case. Conclusion A 4-month rifampin course is an excellent option for LTBI among KTC due to its high completion rate and favorable liver safety profile; however, close monitoring for AHD interactions is essential.