Latent tuberculosis infection and renal transplantation – Diagnosis and management

Abstract

Background: Tuberculosis (TB) continues to be the commonest infectious disease cause of death worldwide. Tuberculosis is an important infectious disease cause of morbidity and death in renal transplant recipients. Tuberculosis can also cause loss of kidney allograft. Objectives: The purpose of this viewpoint is to highlight the issues related to prevention, diagnosis and treatment of tuberculosis in renal transplant recipients. Methods: The PubMed database was searched for publications and guidelines on diagnosis and management of LTBI in renal transplantation. Publications on renal allograft recipients with LTBI and TB in post-operative period were also analysed. Specialist Society guidelines were also used. Findings: Tuberculosis is one of the most important infectious disease-related causes of morbidity and death in transplant recipients. LTBI in allograft recipients continues to be a clinical management problem. It can occur either from donor kidney or from endogenous reactivation of latent tuberculosis infection or from acquiring new Mycobacterium tuberculosis infection. Tuberculosis can also cause loss of kidney allograft. Conclusions: Kidney transplantation is now universally performed in high and low Tuberculosis endemic countries. A high index of awareness of the possibility of TB disease or LTBI is required prior to renal transplant aligned to reduce renal allograft damage, morbidity and death due to tuberculosis. WHO Management recommendations for LTBI screening and treatment should be followed.

Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control

“…In addition, preoperative LTBI has been identified as a risk factor for developing TB [ 8 ]. Once TB develops in patients with kidney transplantation, morbidity is high, approximately 6.1–8.9% [ 6 , 7 , 9 , 10 ], and TB may cause loss of the renal allograft [ 11 ] because the manifestations of TB are atypical and delayed diagnosis ensues [ 9 , 10 ]. Therefore, LTBI and TB are clinical concerns for patients belonging to the KTC and KTR groups.…”

A case of tuberculosis mimicking lung cancer in a kidney transplant recipient

“…Increased prevalence of tuberculosis has been observed among kidney transplant recipients. 1,2 This case is important for two reasons; first, lesions on CT mimicked and were highly suspicious for lung cancer and second the diagnosis would have been missed without the BAL fluid culture, underlying the importance of BAL in this patient population. Post-transplant tuberculosis can present across a wide range of symptoms, even mimicking cancer as in our patient.…”

World Tuberculosis Day March 24th 2019 Theme: “It’s TIME” — International Journal of Infectious Diseases Tuberculosis Theme Series

“…Tuberculosis can also cause loss of kidney allograft. Krishnamoorthy et al (2019) highlight the issues related to prevention, diagnosis and treatment of tuberculosis in renal transplant recipients. Most of the TB cases in renal transplant recipients are due to re-activation of LTBI in the recipient or from the donor kidney.…”