Last updated March 14, 2022

Mycobacterium Tuberculosis Infections In Solid Organ Transplantation

Recommendations

All transplant candidates should undergo screening for TB with careful epidemiologic history, exam, TST or IGRA testing, and CXR or Chest CT. (Moderate, Strong)
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Transplant candidates with positive TST or IGRA should be considered for latent TB therapy once active TB is ruled out. (Moderate, Strong)
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IGRA may have advantages over TST in transplant, especially in those who received prior BCG vaccine, or have end‐stage renal disease or advanced liver disease. (Low, Strong)
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Those with high epidemiologic risk (including close or prolonged contact with a case of active TB) and/or chest radiographic evidence of prior TB without adequate treatment should be considered for latent TB therapy even with an indeterminate or negative TST or IGRA test. (Low, Strong)
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Those who have received an organ from a donor who is TST‐positive, had recent exposure to active TB, or had radiographic evidence of untreated TB should be considered for latent TB therapy. (Low, Strong)
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All living donors should undergo screening for TB and should be evaluated for a need for therapy. (Low, Strong)
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Active TB in the donor is a contraindication to organ donation, and active TB in a transplant candidate needs to be treated prior to transplant. (Moderate, Strong)
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TREATMENT OF ACTIVE TB

First‐line therapy for transplant patients with active TB disease is the same as for immunocompetent and other hosts. (High, Strong)
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Daily dosing of active TB therapy is recommended as opposed to twice‐ or thrice‐weekly dosing. (Moderate, Strong)
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Treatment duration for uncomplicated pulmonary TB is at least 6 months, but longer for cavitary disease or disease with persistent sputum culture‐positive status after 2 months of therapy. (High, Strong)
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Treatment duration

  • for bone and joint disease (6‐9 months)
(High, Strong)
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  • for central nervous system disease (9‐12 months)
(, )
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  • severe disseminated disease (6‐9 months)
(Moderate, Strong)

is longer.

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Directly observed therapy (DOT) programs are recommended for transplant recipients. (Moderate, Strong)
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Recommendation Grading

Overview

Title

Mycobacterium Tuberculosis Infections In Solid Organ Transplantation

Authoring Organization

Publication Month/Year

March 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tuberculosis in the pre‐ and post‐transplant period.

Target Patient Population

Pre-/post-transplant recipient

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Prevention, Management

Diseases/Conditions (MeSH)

D014180 - Transplantation, D019737 - Transplants, D009161 - Mycobacterium, D009164 - Mycobacterium Infections, D009169 - Mycobacterium tuberculosis

Keywords

Mycobacterium tuberculosis, transplant

Source Citation

Subramanian, AK, Theodoropoulos, NM; on behalf of the Infectious Diseases Community of Practice of the American Society of Transplantation. Mycobacterium tuberculosis infections in solid organ transplantation: Guidelines from the infectious diseases community of practice of the American Society of Transplantation. Clin Transplant. 2019; 33:e13513.