Diagnosis and Management of Tuberculosis in Transplant Donors: A Donor-Derived Infections Consensus Conference Report

Abstract

Mycobacterium tuberculosis is a ubiquitous organism that infects one-third of the world's population. In previous decades, access to organ transplantation was restricted to academic medical centers in more developed, low tuberculosis (TB) incidence countries. Globalization, changing immigration patterns, and the expansion of sophisticated medical procedures to medium and high TB incidence countries have made tuberculosis an increasingly important posttransplant infectious disease. Tuberculosis is now one of the most common bacterial causes of solid-organ transplant donor-derived infection reported in transplant recipients in the United States. Recognition of latent or undiagnosed active TB in the potential organ donor is critical to prevent emergence of disease in the recipient posttransplant. Donor-derived tuberculosis after transplantation is associated with significant morbidity and mortality, which can best be prevented through careful screening and targeted treatment. To address this growing challenge and provide recommendations, an expert international working group was assembled including specialists in transplant infectious diseases, transplant surgery, organ procurement and TB epidemiology, diagnostics and management. This working group reviewed the currently available data to formulate consensus recommendations for screening and management of TB in organ donors.

Comparison of Cytomegalovirus (CMV) Enzyme-Linked Immunosorbent Spot and CMV Quantiferon Gamma Interferon-Releasing Assays in Assessing Risk of CMV Infection in Kidney Transplant Recipients

“…Both the T-SPOT TB and the TBGold are FDA-approved tests for use in humans and display similar characteristics in assessing tuberculosis infection in immunocompetent subjects (25,26). Reports also indicate that the T-SPOT TB test may be useful in an immunosuppressed population since it has a higher sensitivity than that of the TB-Gold test (27,28).…”

Mycobacterium Tuberculosis in Solid Organ Transplantation: Incidence before and after Expanded Isoniazid Prophylaxis

“…Another source of tuberculosis in SOT is from donor organs. 17,18 The efforts of transplant programs to prevent reactivation of LTBI have focused mainly on the recipients. Recently, screening donors for LTBI has been implemented in many programs.…”

“…Recently, screening donors for LTBI has been implemented in many programs. 18,19 In our organization, we started screening living-related kidney donors for LTBI in 2001. Performing TST on deceased donors is not practical.…”

Comparative Analysis of Assays for Detection of Cell-Mediated Immunity Toward Cytomegalovirus and M. tuberculosis in Samples From Deceased Organ Donors

“…IGRAs have been extensively evaluated to characterize antigen-specific cellular immunity in both healthy and immunocompromised individuals, whereas their performance characteristics in samples from deceased donors are unknown. The need for further research into the utility of IGRAs in deceased donors was also emphasized in a recent consensus report on the diagnosis and management of tuberculosis in transplant donors (1).…”