<i>Mycobacterium tuberculosis</i>after solid organ transplantation: A review of more than 2000 cases

Abad, Cybele Lara; Razonable, Raymund R.

doi:10.1111/ctr.13259

Cited by 81 publications

(113 citation statements)

References 182 publications

(563 reference statements)

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“…The median duration was 10 months, with lung transplant recipients given longer duration of treatment. We recommend induction therapy with 3 or 4‐drug therapy, use of a rifampin‐sparing regimen when available, de‐escalation to 2‐drug treatment based on susceptibility data, and prolonged treatment for 12 months …”

Section: Discussionmentioning

confidence: 99%

Donor derived Mycobacterium tuberculosis infection after solid‐organ transplantation: A comprehensive review

Abad

Razonable

2018

Transplant Infectious Dis

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Section: Discussionmentioning

confidence: 99%

Donor derived Mycobacterium tuberculosis infection after solid‐organ transplantation: A comprehensive review

Abad

Razonable

2018

Transplant Infectious Dis

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“…The presence of pleural effusion or empyema suggests a range of etiologies including community-acquired and hospital-acquired bacterial pneumonia, Cryptococcus and other fungal infections, or tuberculosis depending on the clinical presentation and exposure history. 25,26 Epidemiology, environmental exposures, and seasonality also significantly influence pneumonia etiologies. Geographic location of the donor and recipient may impart risk for endemic fungal infections (Histoplasma, Coccidioides, Blastomyces, Penicillium), TB, or Burkholderia pseudomallei.…”

Section: Considerations Impacting Differential Diagnosismentioning

confidence: 99%

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Dulek

Mueller

2019

Clinical Transplantation

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Pneumonia is a frequent infectious complication of solid organ transplantation (SOT). The occurrence of post-transplant pneumonia adversely impacts both graft and recipient survival, as well as the cost of care for SOT recipients. 1 Numerous micro-organisms can cause pneumonia in the SOT recipient with some etiologies resulting in self-limited infection and others causing significant morbidity and mortality. As a result of the varied clinical presentations and etiologies of pneumonia in SOT recipients, arriving at a specific microbiologic diagnosis can be challenging but is important for optimal care, especially with complicated or refractory pneumonias. In this section, the clinical presentation, differential diagnosis, diagnostic testing, and empiric antimicrobial treatment of pneumonia in SOT recipients are reviewed. Pathogen-specific sections within the AST ID Guidelines are referenced for further information regarding the diagnosis and treatment of specific pathogens that cause pneumonia in this vulnerable population. AbstractThese guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post-transplant period. Clinical presentations and differential diagnosis for pneumonia in the solid organ transplant recipient are reviewed. A two-tier approach is proposed based on the net state of immunosuppression and the severity of presentation. With a lower risk of opportunistic, hospital-acquired, or exposure-specific pathogens and a non-severe presentation, empirical therapy may be initiated under close clinical observation. In all other patients, or those not responding to the initial therapy, a more aggressive diagnostic approach including sampling of tissue for microbiological and pathological testing is warranted. Given the broad range of potential pathogens, a microbiological diagnosis is often key for optimal care. Given the limited literature comparatively evaluating diagnostic approaches to pneumonia in the solid organ transplant recipient, much of the proposed diagnostic algorithm reflects clinical experience rather than evidencebased data. It should serve as a template which may be modified according to local needs. The same holds true for the suggested empiric therapies, which need to be adapted to the local resistance patterns. Further study is needed to comparatively evaluate diagnostic and empiric treatment strategies in SOT recipients. K E Y W O R D Sdiagnosis, pneumonia, transplantation

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“…The cumulative risk of tuberculosis in liver transplantation is estimated to be 0.8 percent in developed countries and 2 percent in developing countries . The disease is associated with significant morbidity and mortality in developed and developing countries . The risk varies depending on transplanted organ and tuberculosis epidemiology in the donor/recipient population.…”

Section: Introductionmentioning

confidence: 99%

“…The risk varies depending on transplanted organ and tuberculosis epidemiology in the donor/recipient population. Reports of tuberculosis incidence after solid organ transplantation have ranged from 10 to more than 100 times that of the general population . The majority of these cases are related to reactivation of disease after transplantation, and less commonly related to new exposure after transplantation, or infection from donor organs .…”

Section: Introductionmentioning

confidence: 99%

Mycobacterium tuberculosis DNA in living donor transplanted livers and donor‐related tuberculosis in recipients: A retrospective longitudinal cohort study

Alrajhi

Alotaibi

Alghamdi

et al. 2019

Transplant Infectious Dis

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Objectives Mycobacterium tuberculosis DNA has been detected in multiple organs in people without active tuberculosis or a history of tuberculosis. Molecular testing for metabolic activity has suggested that M tuberculosis DNA represents viable bacilli. Whether transplanted organs with M tuberculosis DNA can result in tuberculosis in recipients has not been assessed. Methods Biopsies obtained at the time of living donor liver transplantation were tested for the presence of M tuberculosis DNA using in situ PCR. The cohort of recipients was longitudinally followed for the development of tuberculosis. Results Living donor liver transplantation was performed for 270 patients. Mean age was 33 years (median: 41 years, range: 1‐80 years). Recipients were followed for a mean of 68 months (median: 72 months, range: 1‐138 months) after transplantation. Mycobacterium tuberculosis DNA was detected in 25 of 155 donated livers (16%) with liver biopsies available for testing. None of the recipients of these livers received tuberculosis chemoprophylaxis and only one (4%) developed tuberculosis 15 months after transplantation. Among the entire cohort of 270 patients, post‐transplant tuberculosis was diagnosed in four patients (1.48%) at an incidence rate of 2.61 cases per 1000 transplant‐years. No factors associated with developing tuberculosis were identified, including positive M tuberculosis DNA in transplanted livers. Conclusions Mycobacterium tuberculosis DNA in living donor transplanted livers did not result in tuberculosis despite post‐transplant immunosuppression.

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Mycobacterium tuberculosisafter solid organ transplantation: A review of more than 2000 cases

Abstract: This large review highlights the complexity of TB after SOT. Reactivation TB, donor-transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction.

Cited by 81 publications

References 182 publications

Donor derived Mycobacterium tuberculosis infection after solid‐organ transplantation: A comprehensive review

Donor derived Mycobacterium tuberculosis infection after solid‐organ transplantation: A comprehensive review

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Mycobacterium tuberculosis DNA in living donor transplanted livers and donor‐related tuberculosis in recipients: A retrospective longitudinal cohort study

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