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Treating tuberculosis in solid organ transplant recipients

Sun, Hsin-Yun

Current Opinion in Infectious Diseases: December 2014 - Volume 27 - Issue 6 - p 501–505
doi: 10.1097/QCO.0000000000000102
ANTIMICROBIALS: Edited by Monica A. Slavin and William Irving

Purpose of review: To summarize recent findings in the management of active tuberculosis (TB) in solid organ transplant (SOT) recipients.

Recent findings: Mycobacterium tuberculosis causes substantial morbidity and mortality in SOT recipients. According to the literature, transplantation might not be an absolute contraindication for patients with active TB. Although the use of rifampin, resulting in the decreased levels of calcineurin inhibitors, might lead to rejection, studies showed that rifampin-based regimens did not appear to be associated with post-TB rejection or mortality. Nevertheless, judicious adjustment and close monitoring of immunosuppressant levels during concurrent rifampin use for patients with active TB are needed. TB-associated immune reconstitution syndrome occurred in 14% of SOT recipients; liver transplantation, cytomegalovirus infection, and rifampin use are identified risk factors for the development of immune reconstitution syndrome.

Summary: Patients with active TB might be able to undergo transplantation if indicated. Rifampin-based regimen can be considered in the treatment of TB in SOT recipients. In addition to HIV-positive patients, immune reconstitution syndrome also occurs in SOT recipients, and deserves the recognition by primary care physicians to avoid unnecessary management.

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Correspondence to Hsin-Yun Sun, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan. Tel: +886 2 23123456 x 63557; fax: +886 2 23707772; e-mail: hysun@ntu.edu.tw

© 2014 Lippincott Williams & Wilkins, Inc.