Tuberculosis in solid organ transplant patients

Doblas, Antonio; Alcaide, Fernando; Benito, Natividad; Gurguí, Mercé; Torre‐Cisneros, Julián

doi:10.1016/s0213-005x(12)70080-0

Cited by 11 publications

(10 citation statements)

References 47 publications

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“…Although the majority of patients develop pulmonary TB, the percentage of SOT recipients who develop extrapulmonary or disseminated TB is higher than in the general population . Immune reconstitution and haemo‐phagocytic syndrome associated with TB have also been reported in SOT recipients .…”

Section: Introductionmentioning

confidence: 99%

Mycobacterial infections in solid organ transplant recipients

Meije

Piersimoni

Torre‐Cisneros

et al. 2014

Clinical Microbiology and Infection

110

116

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Mycobacterial infections represent a growing challenge for solid organ transplant recipients (SOT). The adverse effects of tuberculosis (TB) therapy present a major difficulty, due to the interactions with immunosuppressive drugs and direct drug toxicity. While TB may be donor-transmitted or community-acquired, it usually develops at a latent infection site in the recipient. Pre-transplant prevention efforts will improve transplant outcomes and avoid the complications associated with post-transplant diagnosis and treatment. The present review and consensus manuscript is based on the updated published information and expert recommendations. The current data about epidemiology, diagnosis, new regimens for the treatment of latent TB infection (LTBI), the experience with rifamycins for the treatment of active TB in the post-transplant period and the experience with isoniazid for LTBI in the liver transplant population, are also reviewed. We attempt to provide useful recommendations for each transplant period and problem concerning mycobacterial infections in SOT recipients.

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Section: Introductionmentioning

confidence: 99%

Mycobacterial infections in solid organ transplant recipients

Meije

Piersimoni

Torre‐Cisneros

et al. 2014

Clinical Microbiology and Infection

110

116

View full text Add to dashboard Cite

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“…Tuberculosis remains one of the most serious posttransplant infections, with mortality rates of 10-40% [1,2,5,[7][8][9][10][11]. Despite recently published guidelines for the management of post-transplant tuberculosis [12][13][14][15], the diagnosis and treatment of tuberculosis after transplantation remain challenging, because of the potential side effects of antituberculous agents and interactions with immunosuppressive drugs [2,3,[16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Clinical features and outcomes of tuberculosis in transplant recipients as compared with the general population: a retrospective matched cohort study

Benito

García-Vázquez

Horcajada

et al. 2015

Clinical Microbiology and Infection

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There are no previous studies comparing tuberculosis in transplant recipients (TRs) with other hosts. We compared the characteristics and outcomes of tuberculosis in TRs and patients from the general population. Twenty-two TRs who developed tuberculosis from 1996 through 2010 at a tertiary hospital were included. Each TR was matched by age, gender and year of diagnosis with four controls selected from among non-TR non-human immunodeficiency virus patients with tuberculosis. TRs (21 patients, 96%) had more factors predisposing to tuberculosis than non-TRs (33, 38%) (p <0.001). Pulmonary tuberculosis was more common in non-TRs (77 (88%) vs. 12 TRs (55%); p 0.001); disseminated tuberculosis was more frequent in TRs (five (23%) vs. four non-TRs (5%); p 0.005). Time from clinical suspicion of tuberculosis to definitive diagnosis was longer in TRs (median of 14 days) than in non-TRs (median of 0 days) (p <0.001), and invasive procedures were more often required (12 (55%) TRs and 15 (17%) non-TRs, respectively; p 0.001). Tuberculosis was diagnosed post-mortem in three TRs (14%) and in no non-TRs (p <0.001). Rates of toxicity associated with antituberculous therapy were 38% in TRs (six patients) and 10% (seven patients) in non-TRs (p 0.014). Tuberculosis-related mortality rates in TRs and non-TRs were 18% and 6%, respectively (p 0.057). The adjusted Cox regression analysis showed that the only predictor of tuberculosis-related mortality was a higher number of organs with tuberculosis involvement (adjusted hazard ratio 8.6; 95% CI 1.2-63). In conclusion, manifestations of tuberculosis in TRs differ from those in normal hosts. Post-transplant tuberculosis resists timely diagnosis, and is associated with a higher risk of death before a diagnosis can be made.

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“…3,4 Many studies have described TB as a factor that facilitates organ rejection due to drugdrug interactions between anti-TB and immunosuppressive agents. [17][18][19] Therefore, TB remains an important topic for both clinicians and patients in the posttransplant period. The literature reports that the prevalence for TB in SOT recipients in low-endemicity areas is between 0.2% and 6.4%.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. Conclusions:Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.

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Tuberculosis in solid organ transplant patients

Cited by 11 publications

References 47 publications

Mycobacterial infections in solid organ transplant recipients

Mycobacterial infections in solid organ transplant recipients

Clinical features and outcomes of tuberculosis in transplant recipients as compared with the general population: a retrospective matched cohort study

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