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Mycobacterium tuberculosis after Solid-Organ Transplantation: A Review of More than 2000 Cases.

Mycobacterium tuberculosis after Solid-Organ Transplantation: A Review of More than 2000 Cases.
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Abad CLR, Razonable RR,


Abad CLR, Razonable RR, (click to view)

Abad CLR, Razonable RR,

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Clinical transplantation 2018 04 15() e13259 doi 10.1111/ctr.13259
Abstract
BACKGROUND
Mycobacterium tuberculosis (TB) is a common pathogen worldwide, and it may cause significant infection after solid organ transplantation (SOT). We reviewed all reported TB cases to provide an update on its epidemiology, clinical presentation, management and outcome after SOT.

METHODS
MEDLINE, EMBASE, and OVID were reviewed from January 1, 1998 to Dec 31, 2016 using key words tuberculosis and solid organ transplant or transplantation.

RESULTS
There were 187 publications reporting 2082 cases of TB among kidney (n=1719), liver (n=253), heart (n=77), lung (n=25), and kidney-pancreas (n=8) recipients. Among cohort studies, the median incidence was 2.37% (range, 0.05-13.27%) overall. Most TB disease was considered reactivation of latent infection, occurring beyond the first year after SOT. Early-onset cases were seen among donor-derived TB cases. Fever was the most common symptom. Radiologic findings were highly variable. Extrapulmonary and disseminated TB occurred 29.84% and 15.96%, respectively. Multi-drug resistant TB was rare. Treatment using 4 or 5 drugs was commonly associated with hepatotoxicity and graft dysfunction. All-cause mortality was 18.84%.

CONCLUSIONS
This large review highlights the complexity of TB after SOT. Reactivation TB, donor-transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction. This article is protected by copyright. All rights reserved.

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