<i>Mycobacterium tuberculosis</i>Infection in Solid‐Organ Transplant Recipients: Impact and Implications for Management

TLDR

Tuberculosis is a serious opportunistic infection in organ transplant recipients, with worldwide incidence ranging from 0.35% to 15%. The study aims to highlight the unique epidemiological and clinical characteristics of tuberculosis in transplant recipients to guide diagnosis and effective management. In 499 transplant patients with tuberculosis, infection within 12 months was predicted by nonrenal transplant, recent rejection, and immunosuppressive regimen, 33% had disseminated disease driven by OKT3 or anti‑T cell antibodies, overall mortality was 29% with disseminated infection, prior rejection, and these antibodies as major predictors, and hepatotoxicity rates ranged from 2.5% in renal to 41% in liver transplant recipients.

Abstract

Tuberculosis is a serious opportunistic infection in transplant recipients. On the basis of the compilation of published reports in the literature, the incidence of Mycobacterium tuberculosis infection in organ transplant recipients worldwide ranged from 0.35% to 15%. Nonrenal transplantation (P = .004), rejection within 6 months before the onset of tuberculosis (P = .02) and type of primary immunosuppressive regimen (P = .007) were predictors of M. tuberculosis infection occurring within 12 months after transplantation. Thirty-three percent (155) of 476 transplant patients with tuberculosis had disseminated infection; receipt of OKT3 or anti-T cell antibodies (P = .005) was a significant predictor of disseminated tuberculosis. Overall, the mortality rate among 499 patients was 29%; disseminated infection (P = .0003), prior rejection (P = .006), and receipt of OKT3 or anti-T cell antibodies (P = .0013) were significant predictors of mortality in patients with tuberculosis. Clinically significant hepatotoxicity due to isoniazid occurred in 2.5%, 4.5%, and 41% of renal, heart and lung, and liver transplant recipients, respectively. The diagnosis and effective management of tuberculosis after transplantation warrant recognition of the unique epidemiological and clinical characteristics of tuberculosis in transplant recipients.