Tuberculosis in solid organ transplant candidates and recipients: Current and future challenges

Aruna K. Subramanian

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of review Tuberculosis (TB) infection in solid organ transplant recipients poses unique diagnostic and treatment challenges. Recent guidelines for prevention of donor-derived TB and updates on TB diagnostics and treatment in the transplant setting are reviewed as follows. Recent findings Prevention of donor-derived TB can be optimized by careful screening of donors with risk factors for TB, with effort taken to rule out active TB in the donor, and targeted treatment of recipients. However, transmission may still occur, especially through lung allografts, given limitations of screening tests and treatment strategies. Diagnostics for latent tuberculosis infection are limited in sensitivity and have a relatively low predictive value for development of active TB. Treatment options for latent and active TB carry risks that are still being elucidated in transplant patients, such as a dysregulated inflammatory response manifested by immune reconstitution syndrome. Summary More sensitive diagnostics in deceased donors are needed to quantify the risk of TB transmission and the risk of progression to active tuberculosis in those with latent tuberculosis infection prior to transplant. Novel TB therapies of shorter duration with less toxicity for both latent and active TB will be of great benefit to transplant patients.

Original languageEnglish (US)
Pages (from-to)316-321
Number of pages6
JournalCurrent opinion in infectious diseases
Volume27
Issue number4
DOIs
StatePublished - Aug 2014

Keywords

  • Immune reconstitution syndrome
  • Interferon-g release assay
  • Isoniazid
  • Solid organ transplantation
  • Tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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