Challenging issues in tuberculosis in solid organ transplantation

Clin Infect Dis. 2013 Nov;57(10):1473-82. doi: 10.1093/cid/cit488. Epub 2013 Jul 29.

Abstract

Solid organ transplant (SOT) recipients are at risk for opportunistic infections including tuberculosis. Although guidelines on the management of latent tuberculosis and active tuberculosis are available, there remain a number of clinical areas with limited guidance. We discuss challenges in the diagnosis, management, and treatment of latent and active tuberculosis in SOT candidates and recipients who reside in low-tuberculosis-prevalence areas. We discuss the diagnosis of latent tuberculosis in SOT candidates/recipients using tuberculin skin tests and interferon-γ release assays and risk stratification of SOT candidates/recipients that would identify individuals at high risk for latent tuberculosis despite negative test results. Through a careful review of posttransplant tuberculosis cases, we identify a history of treated tuberculosis in SOT recipients as a risk factor for development of posttransplant active tuberculosis. Finally, we include comparisons of recommendations by several large transplant organizations and identify areas for future research.

Keywords: solid organ transplant; tuberculosis.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Female
  • Humans
  • Male
  • Middle Aged
  • Transplantation / adverse effects*
  • Tuberculosis / diagnosis
  • Tuberculosis / drug therapy
  • Tuberculosis / etiology*