The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Dragos Bumbacea, Sandra M Arend, Fusun Eyuboglu, Jay A Fishman, Delia Goletti, Michael G Ison, Christine E Jones, Beate Kampmann, Camille N Kotton, Christoph Lange, Per Ljungman, Heather Milburn, Michele I Morris, Elmi Muller, Patricia Muñoz, Anoma Nellore, Hans L Rieder, Urban Sester, Nicole Theodoropoulos, Dirk Wagner, Martina Sester
European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology 2012, 40 (4): 990-1013
Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-γ based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking.

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