TY - JOUR
T1 - Management and diagnosis of tuberculosis in solid organ transplant candidates and recipients
T2 - Expert survey and updated review
AU - Pennington, Kelly M.
AU - Kennedy, Cassie C.
AU - Chandra, Subhash
AU - Lauzardo, Michael
AU - Brito, Maximo O.
AU - Griffith, David E.
AU - Seaworth, Barbara J.
AU - Escalante, Patricio
N1 - Funding Information:
The authors want acknowledge the wonderful enthusiasm and detailed data analysis work from the late Dr. Kate E. Birkenkamp from the Mayo Clinic, who passed away unexpectedly before the writing process of this manuscript. We also appreciate the valuable input and original support from Dr. Bonita T. Mangura from the UMDNJ-New Jersey Medical School and Global TB Institute, Newark, NJ, and Dr. Jeremy A. Falk from the Lung Transplant Program at Cedars Sinai Hospital, Los Angeles, CA. The survey was approved as a Chest Infections Network project and supported by the American College of Chest Physicians. Support included funding for a face-to-face meeting and on-line survey engine support. No other financial or material support was provided to the authors and participants. The sponsors had no role in analysis of the data or drafting of the manuscript.
PY - 2018/5
Y1 - 2018/5
N2 - Background: Optimal screening and management of latent tuberculosis infection (LTBI) and active tuberculosis (TB) in solid organ transplant (SOT) candidates and recipients is necessary to prevent morbidity and mortality. Methods: We conducted a cross-sectional survey of TB and transplant experts across the United States reviewing the clinical practice preferences on key management issues related to LTBI and TB in SOT candidates and recipients. Results: Thirty TB and 13 SOT experts were surveyed (response rate = 53.8%). Both groups agreed that tuberculin skin test (TST) and chest x-ray screening in SOT candidates was useful (78.6% and 84.6%, respectively). TST after SOT was not useful for most transplant experts and TB experts (0% vs. 32.1%, respectively), but both groups were split on usefulness of interferon gamma release assays (IGRA) in SOT recipients (42.9% TB experts vs. 46.2% SOT experts). Most experts recommend LTBI treatment prior to SOT if close monitoring is assured (82.1% TB experts vs. 76.9% transplant experts). LTBI treatment with isoniazid was preferred for patients on calcineurin inhibitors. Evaluation for suspected TB in SOT recipients varied, but most TB experts favored sputum testing (88.9%) whereas most transplant experts favored bronchoscopic testing (69.2%). Preferred TB treatment regimens in SOT recipients were similar to regimens recommended for immunocompetent patients. Conclusions: Most TB and transplant experts recommend evaluation and treatment for LTBI in SOT candidates. Liver transplant candidates, however, should only be treated if close monitoring can be assured and after consulting with a hepatologist. Practice preferences varied regarding the initial diagnostic approach for suspected TB in SOT recipients; however, most experts agreed that SOT recipients should receive similar treatments as immunocompetent patients.
AB - Background: Optimal screening and management of latent tuberculosis infection (LTBI) and active tuberculosis (TB) in solid organ transplant (SOT) candidates and recipients is necessary to prevent morbidity and mortality. Methods: We conducted a cross-sectional survey of TB and transplant experts across the United States reviewing the clinical practice preferences on key management issues related to LTBI and TB in SOT candidates and recipients. Results: Thirty TB and 13 SOT experts were surveyed (response rate = 53.8%). Both groups agreed that tuberculin skin test (TST) and chest x-ray screening in SOT candidates was useful (78.6% and 84.6%, respectively). TST after SOT was not useful for most transplant experts and TB experts (0% vs. 32.1%, respectively), but both groups were split on usefulness of interferon gamma release assays (IGRA) in SOT recipients (42.9% TB experts vs. 46.2% SOT experts). Most experts recommend LTBI treatment prior to SOT if close monitoring is assured (82.1% TB experts vs. 76.9% transplant experts). LTBI treatment with isoniazid was preferred for patients on calcineurin inhibitors. Evaluation for suspected TB in SOT recipients varied, but most TB experts favored sputum testing (88.9%) whereas most transplant experts favored bronchoscopic testing (69.2%). Preferred TB treatment regimens in SOT recipients were similar to regimens recommended for immunocompetent patients. Conclusions: Most TB and transplant experts recommend evaluation and treatment for LTBI in SOT candidates. Liver transplant candidates, however, should only be treated if close monitoring can be assured and after consulting with a hepatologist. Practice preferences varied regarding the initial diagnostic approach for suspected TB in SOT recipients; however, most experts agreed that SOT recipients should receive similar treatments as immunocompetent patients.
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U2 - 10.1016/j.jctube.2018.04.001
DO - 10.1016/j.jctube.2018.04.001
M3 - Article
AN - SCOPUS:85045553743
VL - 11
SP - 37
EP - 46
JO - Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
JF - Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
SN - 2405-5794
ER -