Tuberculosis in transplantation: diagnosis, prevention, and treatment

Tuberculosis should always be taken into consideration as a possible infectious complication in transplant recipients. It is more frequent and fatal, and its diagnosis, prevention, and treatment are more challenging, in transplanted patients, as compared with the general population. Latent infection with M. tuberculosis is indirectly diagnosed by assessing the presence of a specific adaptive immune response, but depending on the assay used, the informative value of immunodiagnostic assays may be limited by the inhibitory action of immunosuppressive medication, and the positive predictive value for progression toward active tuberculosis is generally low. Diagnosis of active tuberculosis is challenging, since symptoms in immunocompromised patients are frequently less pronounced and atypical. Finally, treatment of tuberculosis is complicated by unpredictable drug interactions, drug-related organ toxicities, and development of drug resistance. This review provides an overview of the epidemiological characteristics of posttransplant tuberculosis and summarizes current knowledge on the prevention, diagnosis, and treatment of tuberculosis in transplant recipients.