Mycobacterium tuberculosis after solid organ transplantation: A review of more than 2000 cases

Abstract

This large review highlights the complexity of TB after SOT. Reactivation TB, donor-transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction.

Incidence rate of active tuberculosis in solid organ transplant recipients: Data from a nationwide population cohort in a high‐endemic country

“…Interestingly, the IR in our database was very similar to previous studies, such as the 5.0/1000 person‐years found for the 3202 liver transplant recipients in the nationwide cohort from 2000–2011 in Taiwan, the 5.1/1000 person‐years, which included overall transplant organs, found in the Spanish network from 2008, and the 5.1/1000 person‐years in the Chinese liver or kidney transplant recipients from 2000 to 2013 9,43,46 . Our overall frequency of post‐SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB‐endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7‐fold higher than that in non‐SOT individuals, similar to previous reports 12–14 . Considering the follow‐up duration, the IR of post‐SOT TB per 1000 person‐years in our study was similar to that in countries with an intermediate or high burden of TB in the general population 13,14,46 …”

“…9,43,46 Our overall frequency of post-SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB-endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7-fold higher than that in non-SOT individuals, similar to previous reports. [12][13][14] Considering the follow-up duration, the IR of post-SOT TB per 1000 person-years in our study was similar to that in countries with an intermediate or high burden of TB in the general population. 13,14,46 Previous studies have presented the difference in risk of TB according to transplant organs, which may be associated with the general incidence of TB in each country, characteristics of the study population or study period, or the relatively few cases of TB.…”

Incidence rate of active tuberculosis in solid organ transplant recipients: Data from a nationwide population cohort in a high‐endemic country

“…Interestingly, the IR in our database was very similar to previous studies, such as the 5.0/1000 person‐years found for the 3202 liver transplant recipients in the nationwide cohort from 2000–2011 in Taiwan, the 5.1/1000 person‐years, which included overall transplant organs, found in the Spanish network from 2008, and the 5.1/1000 person‐years in the Chinese liver or kidney transplant recipients from 2000 to 2013 9,43,46 . Our overall frequency of post‐SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB‐endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7‐fold higher than that in non‐SOT individuals, similar to previous reports 12–14 . Considering the follow‐up duration, the IR of post‐SOT TB per 1000 person‐years in our study was similar to that in countries with an intermediate or high burden of TB in the general population 13,14,46 …”

“…9,43,46 Our overall frequency of post-SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB-endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7-fold higher than that in non-SOT individuals, similar to previous reports. [12][13][14] Considering the follow-up duration, the IR of post-SOT TB per 1000 person-years in our study was similar to that in countries with an intermediate or high burden of TB in the general population. 13,14,46 Previous studies have presented the difference in risk of TB according to transplant organs, which may be associated with the general incidence of TB in each country, characteristics of the study population or study period, or the relatively few cases of TB.…”

Donor‐derived endemic mycoses after solid organ transplantation: A review of reported cases

“…Recipients with probable and proven donor‐derived endemic mycoses presented with symptoms most commonly within the first month (e.g., a median of .5–.7 months) after transplantation. This time to onset of clinical presentation is similar to other cases of DDI 30,31 . We hypothesize the early timing is strongly related to intensity of immune suppression during this early period in addition to the pathogen burden of disease (e.g., high inoculum).…”

Solid Organ Transplantation Among Transplant Candidates With TB Disease

“…The median duration of therapy for transplant recipients was 12 months (range 4-24), which is consistent with a review of TB cases among SOT recipients treated after SOT [ 2 ]. Although optimal duration has not been studied, this longer duration of treatment compared to the general population is likely given because of the immune suppressed state of transplant recipients.…”

Incidence rate of active tuberculosis in solid organ transplant recipients: Data from a nationwide population cohort in a high‐endemic country

“…Interestingly, the IR in our database was very similar to previous studies, such as the 5.0/1000 person‐years found for the 3202 liver transplant recipients in the nationwide cohort from 2000–2011 in Taiwan, the 5.1/1000 person‐years, which included overall transplant organs, found in the Spanish network from 2008, and the 5.1/1000 person‐years in the Chinese liver or kidney transplant recipients from 2000 to 2013 9,43,46 . Our overall frequency of post‐SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB‐endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7‐fold higher than that in non‐SOT individuals, similar to previous reports 12–14 . Considering the follow‐up duration, the IR of post‐SOT TB per 1000 person‐years in our study was similar to that in countries with an intermediate or high burden of TB in the general population 13,14,46 …”

“…9,43,46 Our overall frequency of post-SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB-endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7-fold higher than that in non-SOT individuals, similar to previous reports. [12][13][14] Considering the follow-up duration, the IR of post-SOT TB per 1000 person-years in our study was similar to that in countries with an intermediate or high burden of TB in the general population. 13,14,46 Previous studies have presented the difference in risk of TB according to transplant organs, which may be associated with the general incidence of TB in each country, characteristics of the study population or study period, or the relatively few cases of TB.…”

Donor‐derived endemic mycoses after solid organ transplantation: A review of reported cases

“…Recipients with probable and proven donor‐derived endemic mycoses presented with symptoms most commonly within the first month (e.g., a median of .5–.7 months) after transplantation. This time to onset of clinical presentation is similar to other cases of DDI 30,31 . We hypothesize the early timing is strongly related to intensity of immune suppression during this early period in addition to the pathogen burden of disease (e.g., high inoculum).…”

Solid Organ Transplantation Among Transplant Candidates With TB Disease

“…The median duration of therapy for transplant recipients was 12 months (range 4-24), which is consistent with a review of TB cases among SOT recipients treated after SOT [ 2 ]. Although optimal duration has not been studied, this longer duration of treatment compared to the general population is likely given because of the immune suppressed state of transplant recipients.…”

Incidence rate of active tuberculosis in solid organ transplant recipients: Data from a nationwide population cohort in a high‐endemic country

“…Interestingly, the IR in our database was very similar to previous studies, such as the 5.0/1000 person‐years found for the 3202 liver transplant recipients in the nationwide cohort from 2000–2011 in Taiwan, the 5.1/1000 person‐years, which included overall transplant organs, found in the Spanish network from 2008, and the 5.1/1000 person‐years in the Chinese liver or kidney transplant recipients from 2000 to 2013 9,43,46 . Our overall frequency of post‐SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB‐endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7‐fold higher than that in non‐SOT individuals, similar to previous reports 12–14 . Considering the follow‐up duration, the IR of post‐SOT TB per 1000 person‐years in our study was similar to that in countries with an intermediate or high burden of TB in the general population 13,14,46 …”

“…9,43,46 Our overall frequency of post-SOT TB (1.4%, between 1.2% for kidney and 3.6% for PTA and SPK) in TB-endemic locations was relatively lower than 2.4% (between 1.0% for lung and 1.7% for kidney transplants) in a comprehensive review performed on the 2082 TB cases reported between 1998 and 2016, but 7-fold higher than that in non-SOT individuals, similar to previous reports. [12][13][14] Considering the follow-up duration, the IR of post-SOT TB per 1000 person-years in our study was similar to that in countries with an intermediate or high burden of TB in the general population. 13,14,46 Previous studies have presented the difference in risk of TB according to transplant organs, which may be associated with the general incidence of TB in each country, characteristics of the study population or study period, or the relatively few cases of TB.…”

Donor‐derived endemic mycoses after solid organ transplantation: A review of reported cases

“…Recipients with probable and proven donor‐derived endemic mycoses presented with symptoms most commonly within the first month (e.g., a median of .5–.7 months) after transplantation. This time to onset of clinical presentation is similar to other cases of DDI 30,31 . We hypothesize the early timing is strongly related to intensity of immune suppression during this early period in addition to the pathogen burden of disease (e.g., high inoculum).…”

Solid Organ Transplantation Among Transplant Candidates With TB Disease

“…The median duration of therapy for transplant recipients was 12 months (range 4-24), which is consistent with a review of TB cases among SOT recipients treated after SOT [ 2 ]. Although optimal duration has not been studied, this longer duration of treatment compared to the general population is likely given because of the immune suppressed state of transplant recipients.…”