Tuberculosis Screening and Treatment in Solid Organ Transplantation

Abstract

Background: Tuberculosis (TB) is a common infection with challenges in diagnosis and treatment. Management of TB in solid organ transplant (SOT) candidates and recipients poses unique challenges not seen in other populations. Questions and recommendations: Latent TB infection (LTBI) is important to diagnose pre-transplant through history, physical examination, imaging, and laboratory tests. Tuberculin skin tests and interferon-gamma release assays are important tools but not sufficiently sensitive nor specific to diagnose LTBI alone. Active TB is more likely to present as a disseminated or extrapulmonary infection. Donor-derived infections occur infrequently though can be serious; these can sometimes be prevented through LTBI treatment of the donor or recipient. Treatment of active or latent TB is similar to that in other populations with particular attention to drug interactions and adverse drug reactions. Conclusions: LTBI and TB are important infections in SOT candidates and recipients with unique challenges though substantial literature and experience have emerged to guide providers.