Mycobacterium tuberculosis in solid organ transplant donors and recipients

Abstract

Purpose of review Due to impaired immune response, solid organ transplant (SOT) recipients are susceptible to tuberculosis (TB) and its subsequent morbidity and mortality. Current prevention strategies, diagnostic and treatment approach to TB infection in donors and recipients were reviewed in this article. Recent findings Screening of latent tuberculosis infection (LTBI) in donors and recipients is the cornerstone of TB-preventive strategy in recipients and requires an assessment of TB risk factors, TB-specific immunity testing, and radiographic evaluation. Interferon-gamma release assay has superseded the tuberculin skin test in LTBI evaluation despite its recognized limitations. LTBI treatment should be offered to transplant candidates and living donors before transplantation and donation, respectively. Diagnosis of TB disease can be challenging because of nonspecific clinical presentation in the recipient and is limited by the sensitivity of current diagnostics. The approach to LTBI and TB disease treatment is similar to the general population, but can be challenging because of potential drug interactions and toxicities. Summary The appropriate evaluation of donors and recipients for TB can mitigate posttransplant TB disease. Current approaches to diagnosis and treatment parallels that of immunocompetent hosts. Future research evaluating existing and novel diagnostics and treatment in transplant recipients is needed.

Donor heart selection: Evidence-based guidelines for providers

“…Bloodborne infections. Recommendation regarding donors with tuberculosis: 208 (See Table 6.) Recommendation regarding donors with increased infection risk: 127,193,[209][210][211][212][213][214][215][216][217][218][219][220][221][222][223][224][225][226] (See also Recommendations regarding emerging viral pathogens: [227][228][229][230][231][232][233][234][235][236][237][238][239][240][241][242][243] (See Table 8.)…”

Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19

“…Anti-SARS-CoV-2 monoclonal antibodies or remdesivir are recommended as first-line therapy for nonhospitalized transplant patients who are also on CNIs or mTOR inhibitors for antirejection. If these medications are unavailable, ritonavir-boosted nirmatrelvir may be administered cautiously, with thorough patient monitoring and transplant specialist consultation[ 83 ].…”

The cascade of care in testing and treatment of latent tuberculosis infection in liver transplant candidates

“…7,8 Patients may be screened using epidemiologic risk factor assessment, chest imaging, or TB-specific cellular immunity measurement either by tuberculin skin test (TST) or interferon-gamma release assays (IGRA). 9 Commercially available IGRAs include T-spot (Oxford Immunotec Ltd, Oxford, UK) and QuantiFERON (QTF)-Gold TB assays (Cellestis, Victoria, Australia). 10 IGRAs are increasingly used for screening LTBI in SOT candidates as they only require a onetime blood draw.…”

“…Therefore, screening LT recipients for LTBI is important to identify and potentially treat individuals at risk for TB reactivation after transplant 7,8 . Patients may be screened using epidemiologic risk factor assessment, chest imaging, or TB‐specific cellular immunity measurement either by tuberculin skin test (TST) or interferon‐gamma release assays (IGRA) 9 . Commercially available IGRAs include T‐spot (Oxford Immunotec Ltd, Oxford, UK) and QuantiFERON (QTF)‐Gold TB assays (Cellestis, Victoria, Australia) 10 .…”