Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease

Milburn, Heather; Ashman, Neil; Davies, P. D. O.; Doffman, Sarah; Drobniewski, Francis; Khoo, Saye; Ormerod, Peter; Ostermann, Marlies; Snelson, C

doi:10.1136/thx.2009.133173

Cited by 79 publications

(74 citation statements)

References 103 publications

(65 reference statements)

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“…Some offer guidance on screening of living and deceased donors in addition to screening and management of LTBI and TB in the recipients. These publications are from the following countries or geographic areas: Canada [152], Europe [153], Spain [30], UK [154], USA [4,155] or global [138]. Four deal specifically with renal transplantation [4,[152][153][154], two with SOT in general [4,30], including some specific information on liver and lung transplants, and one with HSCT [138].…”

Section: Published National Guidelinesmentioning

confidence: 99%

“…These publications are from the following countries or geographic areas: Canada [152], Europe [153], Spain [30], UK [154], USA [4,155] or global [138]. Four deal specifically with renal transplantation [4,[152][153][154], two with SOT in general [4,30], including some specific information on liver and lung transplants, and one with HSCT [138]. In addition, there are four further statements relating to TB and transplantation: one on general testing and treatment of LTBI [156]; a conference update briefly covering cardiac transplantation [157]; a general statement [158]; and a review of the evidence for preventive chemotherapy/chemoprophylaxis [31].…”

Section: Published National Guidelinesmentioning

confidence: 99%

“…A chest radiograph is recommended, to be supplemented by a TST and/or an IGRA by all guidelines. The more recent guidelines [4,138,[154][155][156] include IGRA testing, with or without TST. All suggest screening pre-transplant, preventive therapy for LTBI with isoniazid plus pyridoxine (vitamin B6), monitoring of liver enzymes and full treatment for active TB.…”

Section: Points Of Agreementmentioning

confidence: 99%

“…Considering only English language publications, seven national guidelines have been identified [4,30,138,[152][153][154][155], six of which relate to SOT and one to HSCT. Some offer guidance on screening of living and deceased donors in addition to screening and management of LTBI and TB in the recipients.…”

Section: Published National Guidelinesmentioning

confidence: 99%

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The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

228

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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Section: Published National Guidelinesmentioning

confidence: 99%

Section: Published National Guidelinesmentioning

confidence: 99%

Section: Points Of Agreementmentioning

confidence: 99%

Section: Published National Guidelinesmentioning

confidence: 99%

See 2 more Smart Citations

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

228

261

View full text Add to dashboard Cite

show abstract

“…The morbidity and mortality rates of TB are high, particularly in patients of reproductive age, which results in increased treatment costs for CKD patients and renders TB a serious public health problem [6][7][8] .…”

mentioning

confidence: 99%