Tuberculosis in Renal Transplant Recipients: The Evidence for Prophylaxis

Currie, Andrew; Knight, Simon R.; Morris, Peter J.

doi:10.1097/tp.0b013e3181ecea8d

Cited by 90 publications

(99 citation statements)

References 66 publications

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“…The overall frequency of TB in transplant populations has been estimated to be roughly between 20 and 74 times that of the general population [3,4]. In areas with low endemicity of TB, the prevalence among SOT recipients is 0.5-6.4%, while it has been reported to be as high as 15.2% in highly endemic areas [3,31]. As such, differential preventative strategies are needed for donors or recipients from regions with varying endemicity.…”

Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

“…The rates and risk of TB in transplant recipients are highly dependent upon the key features, such as the frequency of TB in the recipient and donor population, the organ transplanted (highest in lung transplant recipients), the type and intensity of recipient screening for TB, and the use of prior or current anti-TB drug intake, preventively or curatively [4,30,31].…”

Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

“…Apart from TST-or IGRA-positive individuals after targeted screening, treatment of SOT recipients may also be indicated due to a high-risk pretransplant exposure history (even with negative TST or IGRA), residence in an endemic TB region during the early posttransplant period, specific M. tuberculosis exposure post-transplant, or with a donor history of untreated or incompletely treated LTBI or TB [31,76]. In endemic areas, some centres administer isoniazid for a period of time after transplant [31,77]. Recommendations for management of various clinical situations, including involvement of donors with TB, are described later.…”

Section: Prevention Of Tb In Transplant Recipientsmentioning

confidence: 99%

“…Four deal specifically with renal transplantation [4,[152][153][154], two with SOT in general [4,30], including some specific information on liver and lung transplants, and one with HSCT [138]. In addition, there are four further statements relating to TB and transplantation: one on general testing and treatment of LTBI [156]; a conference update briefly covering cardiac transplantation [157]; a general statement [158]; and a review of the evidence for preventive chemotherapy/chemoprophylaxis [31].…”

Section: Published National Guidelinesmentioning

confidence: 99%

See 3 more Smart Citations

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

232

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

Section: Prevention Of Tb In Transplant Recipientsmentioning

confidence: 99%

Section: Published National Guidelinesmentioning

confidence: 99%

See 2 more Smart Citations

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

232

261

View full text Add to dashboard Cite

show abstract

“…The unusual and varied presentations of TB may cause delays in diagnosis and treatment, as reported in the present case. Many reports claim that latent TB treatment with isoniazid for chemoprophylaxis during dialysis is effective in post-transplant patients with a positive TST test 9,10 . Nonetheless, a thorough medical history must be obtained from the family and the patient, and patients on dialysis should be submitted to a TST or an interferon-gamma release assay, if possible 8 .…”

Section: Discussionmentioning

confidence: 99%

Cutaneous and articular tuberculosis in a renal transplant recipient

Moysés-Neto

Drumond

Morgantetti

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Seven months after undergoing kidney transplantation, a 56-year-old woman presented with papules and ulcers in her right forearm. The patient received antibiotics for 8 months with limited improvement. Eleven months after symptom onset, she presented with acute arthritis in her left knee. Asynovial fluid culture yielded Mycobacterium tuberculosis, and a forearm ulcer biopsy showed granulomatous inflammation. After surgical fistulectomy and 12 months of tuberculosis treatment, she was cured. Chronic cutaneous ulcers and articular manifestations in TB are rare, but they should always be considered in the differential diagnosis for immunosuppressed patients. Surgical intervention and prolonged treatment might be necessary.

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Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis

Adamu

Abdu

Abba

et al. 2014

Cochrane Database of Systematic Reviews

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Main resultsWe identified three studies (10 reports) that involved 558 kidney transplant recipients which met our inclusion criteria. All studies were conducted in countries that have high prevalence of TB (India and Pakistan), and investigated isoniazid, an oral antibacterial drug. Control in all studies was no antibiotic prophylaxis. Prophylactic administration of isoniazid reduced the risk of developing TB posttransplant (3 studies, RR 0.35 95% CI 0.14 to 0.89), and there was no significant effect on all-cause mortality (2 studies, RR 1.39, 95% CI 0.70 to 2.78). There was however substantial risk of liver damage (3 studies, RR 2.74, 95% CI 1.22 to 6.17).Reporting of methodological quality parameters was incomplete in all three studies. Overall, risk of bias was assessed as suboptimal. Authors' conclusionsIsoniazid prophylaxis for kidney transplant recipients reduced the risk of developing TB post-transplant. Kidney transplant recipients in settings that have high prevalence of TB should receive isoniazid during the first year following transplant. There is however, significant risk of liver damage, particularly among those who are hepatitis B or C positive. Further studies are needed among recipients of other solid organ transplants and in settings with low prevalence of TB to determine the benefits and harms of anti-TB prophylaxis in those populations.

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Tuberculosis in Renal Transplant Recipients: The Evidence for Prophylaxis

Cited by 90 publications

References 66 publications

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Cutaneous and articular tuberculosis in a renal transplant recipient

Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis

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