Mycobacterial infections in organ transplant recipients

Tuberculosis has a major adverse impact on solid organ transplant recipients; this article attempts to define this fact. The prevalence of posttransplant tuberculosis is increasing globally and currently is 13.7% at our center. The transplant surgery divides the continuum of pretransplant tuberculosis and posttransplant tuberculosis; immunosuppression accounts for a greater severity of the latter. Cyclosporin and tacrolimus are associated with an earlier onset of tuberculosis when compared with prednisolone and azathioprine immunosuppression. Disseminated disease is more common in nonrenal transplants. The risk for developing posttransplant tuberculosis in renal transplant recipients increased 2.25 times independently with cytomegalovirus (CMV) and twice with chronic liver disease; OKT3 treatment enhances the risk 1.8-fold. Tuberculosis occurring after 2 years of transplantation, diabetes mellitus, posttransplant diabetes mellitus, chronic liver disease, CMV, and deep mycoses each independently confer a risk, 1.5-times or higher, for death. Disseminated disease entails a 2-fold risk. Treatment with or without rifampicin is possible; the former is associated with a higher risk for allograft rejection. Isoniazid prophylaxis is recommended for high-risk patients with apparent clinical efficacy. However, in endemic areas, attendant liver disease makes it a difficult goal.