Tuberculosis in solid organ transplant candidates and recipients
- Aruna Subramanian, MD
Aruna Subramanian, MD
- Clinical Associate Professor of Medicine
- Stanford University School of Medicine
The incidence of tuberculosis among solid organ transplant recipients is higher compared with the general population but varies by geographic location [1-3]. The diagnosis of TB in solid organ transplant recipients presents challenges that may lead to treatment delay. These include atypical clinical presentations, increased likelihood of negative tuberculin skin tests and/or interferon-gamma release assays, and negative sputum smear results despite active disease [4-9]. The treatment of tuberculosis in transplant recipients also has its own challenges, which include pharmacokinetic interactions between immunosuppressive and antituberculous medications, allograft-related drug toxicities, and inadequate immune responses to Mycobacterium tuberculosis due to exogenous immunosuppression [4-7].
This topic reviews M. tuberculosis infections in solid organ transplant recipients. Nontuberculous mycobacterial infections in solid organ transplant recipients; bacterial, viral, and fungal infections in lung transplant recipients; and the evaluation, treatment, and prophylaxis of infection in solid organ transplant recipients are reviewed separately. (See "Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients" and "Bacterial infections following lung transplantation" and "Prevention of cytomegalovirus infection in lung transplant recipients" and "Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients" and "Fungal infections following lung transplantation" and "Evaluation for infection before solid organ transplantation" and "Infection in the solid organ transplant recipient" and "Prophylaxis of infections in solid organ transplantation".)
Overview — The prevalence of active tuberculosis (TB) among transplant recipients in developed countries has ranged from 1.2 to 6.4 percent but has been reported to be as high as 10 to 15 percent in endemic regions [4,5,7,10]. (See "Epidemiology of tuberculosis".)
The incidence of TB in solid organ transplant recipients is not well established and varies by geographic location, but the incidence has been shown to be significantly higher among transplant recipients compared with the general population [1-3]. In a prospective study of 4388 solid organ transplant recipients at 16 transplant centers in Spain, the incidence of TB was 512 cases per 100,000 patients per year compared with 19 cases per 100,000 inhabitants per year in the general population . Among solid organ transplant recipients, lung transplant recipients had the highest incidence of TB (2072 cases per 100,000 patients per year).
Transmission — TB occurs most commonly in transplant recipients as a result of reactivation of latent infection in the recipient but also may arise from unrecognized infection in the allograft or acquisition of new infection after transplantation [4,5,11]. There are several reports of TB transmission from the donor allograft to the recipient [5,11,12], especially when the donor country of origin is highly endemic for TB .
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