Tuberculosis Transmitted Through Transplantation

Graham, Julie; Kearns, Angela; Magee, Jeffrey C.; El-Sheikh, M.; Hudson, Mark; Manas, D.; Gould, F.K.; Orr, K.E.; Freeman, Robert J.

doi:10.1053/jinf.2000.0879

Cited by 45 publications

(38 citation statements)

References 8 publications

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“…15 The median time interval between transplant and TB diagnosis has been reported as 9 to 31 months in the literature. 1,9,15,21 In our study group, 16 patients (85%) developed TB 6 months after transplant; TB was detected within the first 3 months after transplant in just 3 patients. Interestingly, all 3 of these patients received pulse steroid therapy within 1 month after transplant.…”

Section: Discussionmentioning

confidence: 52%

“…[3][4][5][6] The prevalence of active TB disease among solid-organ transplant (SOT) recipients was estimated to be 20 to 74 times higher than that of the general population. [7][8][9] Although rare, TB infection presents as various clinical manifestations with increased frequency and severity in transplant recipients. 10 Consequently, TB mortality is also higher (up to 31%) in SOT patients than in immunocompetent individuals (0-24 cases per 100 000 for the USA and Western Europe, and > 1% in South Africa).…”

Section: Introductionmentioning

confidence: 99%

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Untitled

2015

Exp Clin Transplant

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Objectives: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. Conclusions:Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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“…Tuberculosis transmitted by the donor kidney appears very rarely [6,7]. One study estimates the donor to recipient transmission rate in all solid organ transplants to be 4% in the developing world [1].…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium tuberculosis in a renal transplant transmitted from the donor

et al. 2007

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“…30,31 Post-OLT, the likely mechanism of infection is reactivation of a dormant infection, although rare cases of nosocomial and donor transmission have been documented. 32 The onset of tuberculosis can occur within 2 weeks to years after solid organ transplantation. 33 Most patients with tuberculosis (51-64%) have pulmonary infection, although extrapulmonary infection are also common.…”

Section: Tuberculosismentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

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Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

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Tuberculosis Transmitted Through Transplantation

Cited by 45 publications

References 8 publications

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Mycobacterium tuberculosis in a renal transplant transmitted from the donor

Infections After Orthotopic Liver Transplantation

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