Table 3.

Factors Affecting Timing of Latent Tuberculosis Treatment Among Solid Organ Transplant Candidates and Recipients

Factor	Timing
	Pretransplant	Posttransplant
Advantages	Possibly higher efficacy in absence of concurrent immunosuppression Fewer drug–drug interactions Lower medication/pill burden with corresponding better anticipated adherence Generally well tolerated, even in liver transplant candidates	Targets treatment to period of greatest risk for tuberculosis reactivation
Disadvantages	Potentially insufficient calendar time to complete therapy due to unpredictable timing of transplant Difficulties in differentiating drug toxicity from signs/symptoms of underlying organ disease Drug-induced liver injury could be fatal with preexisting advanced liver disease in liver transplant candidates	Possibly lower efficacy in setting of concurrent immunosuppression Additional pill burden to an already complex medication regimen Potentially severe drug interactions with immunosuppressants Higher reported rate of drug-induced liver injury and discontinuation in liver graft recipients Any elevation in liver function tests creates need for extensive evaluation including invasive procedures (eg, liver biopsy to rule out rejection)