Tuberculosis Recommendations for Solid Organ Transplant Recipients and Donors

Clinical Outcomes of Tuberculosis in Recipients After Living Donor Liver Transplantation

“…Aside from the fact that such patients were already immunocompromised as a result of both post-transplant medications and TB itself, several treatment challenges are also present. The issues that are important and must be addressed in the management of such patients were: (1) the start, duration, and completion of TB treatment, (2) the interaction of anti-TB and immunosuppressive medications, and (3) the hepatotoxic side-effect of the anti-TB medications [ 1 , 14 , 15 , 29 ].…”

“…There were 2 main reasons why our LDLT candidates with non-open, active TB eventually underwent LDLT even without starting or completing TB treatment: (1) unrecognized TB prior to LDLT and (2) worsening liver status because of progressive liver failure and aggressive, recurrent HCC. Especially for the latter reason wherein patients urgently need LT, further delay may further increase the risk of more complications and mortality [ 14 , 15 ]. As our results have shown, with our current standard of care described earlier [ 17 – 20 , 24 – 26 , 34 ] and a relatively readily available living donor [ 32 , 35 , 36 ], performing LDLT in patients with active TB is not significantly associated with unfavorable outcome and may be the best option for such patients who developed accelerated liver failure or aggressive, recurrent HCC to achieve favorable outcome.…”

“…One of the most common recommendations is to increase the dosage of the immunosuppressants to 2–5 times the usual dose and combine it with close and regular monitoring of the blood level [ 7 , 8 , 14 , 29 , 30 , 37 , 39 , 40 ]. In our study, following our protocol of using multi-immunosuppressant combination, as described above, 19 (73%) patients received an increase (2–5×) dose of immunosuppressants during TB treatment, with or without the development of decreased immunosuppressant trough levels ( Figure 3 ).…”

“…Another recommendation is to use Rifabutin instead of Rifampicin, which has the same potency against TB but has lesser effect on cytochrome P3A4 [ 1 , 8 , 14 , 30 ]. In our study, there was no significant association between the use of different anti-TB regimens (Rifampicin-based, Rifabutin-based, INH-based) and the development of ADR or overall mortality.…”

“…In Taiwan, a tuberculin skin test is not useful for screening TB infection due to widespread vaccination in childhood [ 19 ]. Interferon gamma release assay (IGRA) testing was also recommended in the diagnosis of TB, but recent studies have shown that its use is limited in critically ill patients [ 21 ] and is not recommended in the diagnosis of active TB infection [ 14 ]. Moreover, this test was not available in our center at the time the present patients were diagnosed with TB.…”