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Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas

  • Transplant and Oncology (M Ison, N Theodoropoulos and S Pergam, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The incidence of tuberculosis (TB) is many fold higher in transplant recipients than in the general population with the highest risk in first year post-transplant. The purpose of this review is to describe the epidemiology, clinical characteristics, management, and outcomes of TB in organ transplant recipients from TB endemic regions and highlight the challenges faced in their management.

Recent Findings

TB can be increasingly difficult to diagnose and manage in transplant recipients. Clinical manifestations are often atypical leading to delay in diagnosis and available diagnostic modalities are limited in their ability to accurately detect TB. Moreover, the treatment of TB is particularly difficult owing to drug–drug interactions with post-transplant medications. Hence, the focus of recent research has been identification and treatment of latent TB infection pre-transplant.

Summary

The prevalence of TB in transplant recipients is reportedly 12% in TB endemic countries compared to 5% in developed countries. The risk is greatest among transplant recipients with residence in a country with high TB burden. The clinical presentation can vary from the classic symptoms to unusual extrapulmonary manifestations, particularly involvement of genitourinary tract in renal transplant recipients. The first-line treatment is similar to that for immunocompetent patients but requires greater vigilance in monitoring of side effects, particularly hepatotoxicity. Longer treatment duration may be needed in those in whom a first-line regimen could not be used or those with drug-resistant TB. All transplant recipients should be screened for latent TB infection (LTBI) and given prophylaxis if found to have evidence of LTBI.

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Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Availability of Data and Materials

All data presented in this study is included in this published article.

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Authors and Affiliations

  1. Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan

    Nosheen Nasir & Iffat Khanum

  2. Indus Hospital & Health Network, Karachi, Pakistan

    Samreen Sarfaraz

  3. Department of Infectious Diseases, DOW University of Health Sciences (DUHS), Karachi, Pakistan

    Tehreem Ansari & Shobha Luxmi

  4. Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan

    Asma Nasim & Sunil Kumar Dodani

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Nasir, N., Sarfaraz, S., Khanum, I. et al. Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas. Curr Infect Dis Rep 23, 14 (2021). https://doi.org/10.1007/s11908-021-00756-z

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