Management and diagnosis of tuberculosis in solid organ transplant candidates and recipients: Expert survey and updated review ,

Abstract

Background: Optimal screening and management of latent tuberculosis infection (LTBI) and active tuberculosis (TB) in solid organ transplant (SOT) candidates and recipients is necessary to prevent morbidity and mortality.Methods: We conducted a cross-sectional survey of TB and transplant experts across the United States reviewing the clinical practice preferences on key management issues related to LTBI and TB in SOT candidates and recipients.Results: Thirty TB and 13 SOT experts were surveyed (response rate = 53.8%). Both groups agreed that tuberculin skin test (TST) and chest x-ray screening in SOT candidates was useful (78.6% and 84.6%, respectively). TST after SOT was not useful for most transplant experts and TB experts (0% vs. 32.1%, respectively), but both groups were split on usefulness of interferon gamma release assays (IGRA) in SOT recipients (42.9% TB experts vs. 46.2% SOT experts). Most experts recommend LTBI treatment prior to SOT if close monitoring is assured (82.1% TB experts vs. 76.9% transplant experts). LTBI treatment with isoniazid was preferred for patients on calcineurin inhibitors. Evaluation for suspected TB in SOT recipients varied, but most TB experts favored sputum testing (88.9%) whereas most transplant experts favored bronchoscopic testing (69.2%). Preferred TB treatment regimens in SOT recipients were similar to regimens recommended for immunocompetent patients.Conclusions: Most TB and transplant experts recommend evaluation and treatment for LTBI in SOT candidates. Liver transplant candidates, however, should only be treated if close monitoring can be assured and after consulting with a hepatologist. Practice preferences varied regarding the initial diagnostic approach for suspected TB in SOT recipients; however, most experts agreed that SOT recipients should receive similar treatments as immunocompetent patients.

A case series of multidrug‐resistant tuberculosis in renal transplant recipients: Challenges in management from a TB endemic country

“…5 The incidence of TB in solid organ transplant (SOT) recipients is between 2.5% and 13.7%, with a higher incidence in high TB burden countries. 6 WHO declared Pakistan 6th among 30 high TB burden countries. The incidence of TB in Pakistan is 263 while that of MDR-TB is 12 per 100 000 population.…”

A Case Series of Extrapulmonary Mycobacterium in Liver Transplant Recipients

“… 1 The most common complications of treatment include drug hepatotoxicity and acute rejection. 1 , 3 , 5 …”

“…1 The most common complications of treatment include drug hepatotoxicity and acute rejection. 1,3,5 The etiology of M. tuberculosis in the above cases was likely reactivation because both patients were able to recall an exposure in their distant past. Although we serve in a nonendemic area, both patients had been tested before transplantation with QuantiFERON and were negative.…”

Bacterial and Viral Infections in Liver Transplantation: New Insights from Clinical and Surgical Perspectives

“…Despite that, tighter liver enzyme monitoring is needed, and careful monitoring for adverse effects is highly recommended in patients with LTBI attending LT during isoniazid or rifampicin prophylaxis [ 54 , 55 ]. In addition, in managing transplant recipients with tuberculosis, the interaction between anti-tuberculous and immunosuppressive medicines, which may increase the risk of graft rejection, is a key concern [ 56 , 57 ]. Despite that, due to the high mortality risk of active or reactivated M. tuberculosis infection, a tuberculin skin or Quantiferon test for M. tuberculosis alongside chest X-ray screening should be considered in all those who are waiting for an LT to allow early prophylaxis in case of positive screening test [ 54 , 56 , 57 , 58 ].…”

“…The immunomodulatory effects of CMV, mediated by impaired T cell and phagocytic function and cytokine dysregulation, can lead to opportunistic infections, rejection, graft loss, and in some cases reduced survival [ 55 , 56 ]. Following primary infection, most immunocompetent individuals remain asymptomatic.…”