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Chapter 33 : Tuberculosis and Organ Transplantation
Category: Clinical Microbiology; Bacterial Pathogenesis
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Mycobacterium tuberculosis is a significant opportunistic pathogen in solid organ transplant (SOT) recipients due to its high morbidity and mortality. The time of onset of symptoms of tuberculosis after transplantation varies. It is quite common for the diagnosis of tuberculosis in SOT recipients to be delayed for weeks, due to absence of clinical suspicion. After transplant, the diagnostic yield of tuberculin skin test is very low but nevertheless remains the first step in post-transplant evaluation of suspected tuberculosis. Patients awaiting an SOT often have cutaneous anergy due to their underlying disease. Cellular immune testing could be performed at the time of the second positive purified protein derivative (PPD) skin test to determine the presence of anergy. Disseminated tuberculosis is an absolute contraindication for the use of any organ for transplantation. Liver transplant recipients present special problems when receiving treatment for latent tuberculosis infection due to the high risk of hepatotoxicity. In liver recipients, the development of liver toxicity is a particular concern during the treatment of tuberculosis. The main problems that can occur after transplantation are the drug interactions and the recurrence of hepatitis C virus infection, which may increase the risk of tuberculosis and favor toxicity. The most common manifestations of tuberculosis-associated immune reconstitution syndrome are fever, lymphadenopathy, and worsening respiratory symptoms. Tuberculosis has important implications in the outcome of transplant patients. The overall mortality rate in solid organ recipients with tuberculosis is as high as 29%.
Key Concept Ranking
- Hepatitis C virus
Prevalence and incidence of tuberculosis in SOT
Risk factors for tuberculosis
Recommendations of the GESITRA ( 75 ) for treatment of tuberculosis in SOT