Treatment of latent TB Infection and the risk of tuberculosis after solid organ transplantation: Comprehensive review

Abad, Cybele Lara; Deziel, Paul J.; Razonable, Raymund R.

doi:10.1111/tid.13178

Cited by 20 publications

(22 citation statements)

References 65 publications

(279 reference statements)

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“…Identification and treatment of LTBI were found to be beneficial, but majority of studies were conducted in non-endemic area. 23 Currently, utility of LTBI treatment prior to transplantation in countries with high burden of TB remains unclear, as there was a potential of acquired infection from community thereafter. Lastly, we demonstrated higher all-cause mortality in KT recipients with active TB, despite universal cure rate.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and clinical outcomes of tuberculosis among kidney transplant recipients in high endemic country

Thitisuriyarax

Vanichanan

Udomkarnjananun

et al. 2021

Transplant Infectious Dis

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Background: Tuberculosis (TB) is considered as a challenge issue in solid organ transplant recipients because of high morbidity and mortality. Active TB after transplant mostly occurs from reactivation of latent infection. Understanding risk factors and clinical information of TB may provide an appropriate prevention and treatment strategies in this specific patient population, however data from high endemic area is scarce.Methods: A matched single-center, case-control study was conducted in our institute. Cases were defined as newly diagnosed confirmed or clinical active TB in patients who underwent kidney transplant (KT) between April 1992 and October 2018.For each case, 5 controls were matched by age and sex. Risk factor associated with TB was determined using univariate and multivariate conditional logistic regression.Results: Between study period, KT was performed in 787 patients. Twenty-seven patients (3.43%) were diagnosed with active TB including 20 confirmed and 7 clinical diagnosed cases. The global incidence of TB in our population was 315 cases per 100 000 patients per year. Among 27 cases, pulmonary involvement was the most common (48.1%) followed by disseminated (18.5%), extrapulmonary (14.8%), pleura (11.1%) and pleuropulmonary (7.4%) TB. Allograft rejection was significantly associated with active TB (P < .001). The median onset duration of infection was 17 months (IQR, 4-59 months) after KT. Twenty-four (88.9%) patients received rifampicin containing regimen for treatment with median duration of 10 months (IQR, 6-12 months).All patients were cured after complete treatment, however those with TB remained having unfavorable outcomes including higher all-cause mortality and graft loss.Conclusions: Incidence rate of TB in KT recipients is higher than normal population.Allograft rejection was identified as a significant risk factor. Increase unfavorable outcomes including graft loss and mortality were also observed among patients with TB.

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Section: Discussionmentioning

confidence: 99%

Risk factors and clinical outcomes of tuberculosis among kidney transplant recipients in high endemic country

Thitisuriyarax

Vanichanan

Udomkarnjananun

et al. 2021

Transplant Infectious Dis

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“…When risk factors are identified, further testing and radiological assessments are warranted. Notwithstanding, active TB is a well-known contraindication to organ donation [4,6,[26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Donor-Derived Tuberculosis: A Case Report and the Role of Communication Gaps in Transplantation Safety

Clemente

Faria

Cota

et al. 2021

Case Reports in Transplantation

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Donor-derived tuberculosis (DD-TB) accounts for less than 5% of TB cases and is considered a rare event. In the transplant setting, the frequency of active TB is estimated to be 20 to 74 times higher than that in the general population, and it is associated with high mortality. In this context, the main strategy to minimize the risk of DD transmission is to identify high-risk donors. Despite screening recommendations, failures may result in a breakdown of safety that ends in the transmission of potentially fatal diseases. This report describes a case of DD-TB and emphasizes communication gaps that may occur between organ procurement organizations and transplant centers. Failure in reporting results, lack of exchanging information regarding recipients from the same donor, and inefficient communication between organ procurement organizations and transplant centers are lacks that may be prevented by a more efficient approach towards screening protocols and communication.

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“…In this sense, treating LTBI before transplantation in patients with expected long waitlisting time may have a waning effect and require retreatment. A recent review also described a large number of centers that prescribe INH after transplantation 35 . Although the potential of more severe drug interactions is greater after transplantation, patients are monitored more closely in the initial months, which could improve the safety of this approach.…”

Section: Discussionmentioning

confidence: 99%

Latent tuberculosis screening before kidney transplantation in the South of Brazil

et al. 2021

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Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

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Treatment of latent TB Infection and the risk of tuberculosis after solid organ transplantation: Comprehensive review

Cited by 20 publications

References 65 publications

Risk factors and clinical outcomes of tuberculosis among kidney transplant recipients in high endemic country

Risk factors and clinical outcomes of tuberculosis among kidney transplant recipients in high endemic country

Donor-Derived Tuberculosis: A Case Report and the Role of Communication Gaps in Transplantation Safety

Latent tuberculosis screening before kidney transplantation in the South of Brazil

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