Tuberculosis in lung and heart transplant recipients

Mycobacterium tuberculosis is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression required to prevent graft rejection. Lung and heart transplant recipients are particularly susceptible to tuberculosis (TB) reactivation, as they often undergo more intensive and prolonged immunosuppressive regimens compared to recipients of other organ transplants with lower immunogenicity. Additionally, the risk of donor-derived TB is notably higher in lung transplantation, underscoring the critical importance of thorough TB screening for both donors and recipients. Implementing appropriate treatment protocols based on screening results is essential to prevent the development of TB disease, which can adversely affect the recipient's prognosis. Diagnosing TB in solid organ transplant recipients presents unique challenges. Immunosuppression can attenuate typical inflammatory responses, leading to atypical or absent symptoms. Moreover, there is a higher incidence of extrapulmonary and disseminated TB in this population, which can result in diagnostic delays. Treatment complexities arise from significant drug interactions, particularly between rifampicin and immunosuppressive agents. Furthermore, there is a lack of high-quality studies evaluating the efficacy of rifampin-free regimens and newer drugs for treating multidrug-resistant TB in transplant recipients. This review focuses on TB in the context of lung and heart transplantation, emphasizing the necessity of pretransplant TB infection screening for both donors and recipients, as well as the management strategies for TB disease following transplantation.