Tuberculosis Management in Solid Organ Transplant Recipients

Solid organ transplant recipients face a substantially increased risk of tuberculosis due to long‐term immunosuppressive therapy that impairs host defences. Incidence rates in this population are reported to be several‐fold higher than in the general community, with both donor‐derived and reactivated latent infections contributing to disease burden. Clinical presentations range from isolated pulmonary disease to disseminated and extrapulmonary forms, often with non‐specific symptoms. Pre‐transplant screening for latent tuberculosis infection using tuberculin skin tests or interferon-gamma release assays is widely recommended, although sensitivity and specificity vary with patient immune status and regional prevalence. Prophylactic regimens, primarily with isoniazid, have been shown to reduce reactivation risk but require vigilant monitoring for hepatotoxicity. Management of active tuberculosis must balance prompt initiation of multi‐drug therapy against potential drug–drug interactions: rifampicin markedly induces cytochrome P450 enzymes, reducing levels of calcineurin inhibitors and necessitating close therapeutic drug monitoring. Extended treatment durations—often nine to twelve months—are advised to prevent relapse. A multidisciplinary approach involving transplant physicians, infectious disease specialists and pharmacologists is imperative to tailor strategies according to donor and recipient risk profiles, regional endemicity and evolving resistance patterns.

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Tuberculosis Management in Solid Organ Transplant Recipients publication trend

The graph below shows the total number of articles in tuberculosis management in solid organ transplant recipients across all publications each year (not limited to Nature Index journals).

Technical terms

Latent tuberculosis infection (LTBI): Persistence of immune sensitisation to Mycobacterium tuberculosis antigens without clinical or radiological signs of active disease.

Isoniazid prophylaxis: Preventive administration of the antibiotic isoniazid to persons with LTBI to avert progression to active tuberculosis.

Immunosuppressive therapy: Pharmacological regimen, including calcineurin inhibitors and corticosteroids, used to prevent graft rejection that concurrently diminishes immune responses to pathogens.

References

1. Chemoprophylaxis for the prevention of tuberculosis in kidney transplant recipients: A systematic review and meta-analysis. Frontiers in Pharmacology (2023).
2. The risk factors for tuberculosis in liver or kidney transplant recipients. BMC Infectious Diseases (2014).
3. Latent tuberculosis infection and renal transplantation – Diagnosis and management. International Journal of Infectious Diseases (2019).
4. Poor predictability of QuantiFERON-TB assay in recipients and donors for tuberculosis development after kidney transplantation in an intermediate-TB-burden country. BMC Nephrology (2017).
5. The Risk of Tuberculosis Transmission in Solid Organ Transplant: Is It More Than a Theoretical Concern?. Canadian Journal of Infectious Diseases and Medical Microbiology (2005).