Mycobacterial infections in solid organ transplant recipients

Area of Science:

• Transplantation immunology and infectious diseases.
• Clinical management of mycobacterial infections in immunocompromised patients.

Background:

• Mycobacterial infections, particularly tuberculosis (TB), pose a significant and increasing threat to solid organ transplant (SOT) recipients.
• Treatment challenges arise from drug interactions with immunosuppressants and direct drug toxicity, complicating patient management.
• TB can be acquired from donors, the community, or reactivation of latent infection in the recipient.

Purpose of the Study:

• To review current data on the epidemiology, diagnosis, and treatment of mycobacterial infections in SOT recipients.
• To provide expert recommendations for managing latent TB infection (LTBI) and active TB in the pre- and post-transplant periods.
• To emphasize the importance of pre-transplant prevention strategies for improving SOT outcomes.

Main Methods:

• Comprehensive review of updated published literature on mycobacterial infections in SOT recipients.
• Incorporation of expert recommendations and consensus guidelines.
• Analysis of data on LTBI treatment regimens, rifamycin use for active TB, and isoniazid for LTBI in liver transplant patients.

Main Results:

• Pre-transplant prevention of TB is essential for better SOT outcomes.
• Specific focus on new LTBI treatment regimens and experiences with rifamycins and isoniazid in the post-transplant setting.
• Data reviewed covers epidemiology, diagnosis, and treatment across different transplant phases.

Conclusions:

• Proactive management and pre-transplant screening for mycobacterial infections are critical in SOT recipients.
• Updated recommendations are provided to address challenges in diagnosis and treatment, including drug interactions and toxicity.
• Effective strategies can mitigate the risks associated with TB in this vulnerable patient population.