Prevention and Treatment of Mycobacterial Infections
Mycobacterial infections represent a growing challenge for solid organ transplant recipients (SOT). Tuberculosis (TB) infection is associated with high transplant failure and mortality rates. Compared to that in the general population, the frequency of TB is round until 50 times higher in SOT recipients. Transplant recipients with TB are also more likely to develop disseminated disease, have longer time to definitive diagnosis (due to atypical presentation or negative/indeterminate diagnostic tests), require more invasive diagnostic procedures, and experience greater anti-TB treatment-related toxicity than the general population. The adverse effects of TB therapy present a major difficulty, due to the interactions with immunosuppressive drugs. The current rise in drug resistance in the Mycobacterium tuberculosis complex (MTC) makes TB therapy even more challenging in some particular areas.
Specific risk factors for TB in SOT recipients include previous exposure to Mycobacterium tuberculosis (positive tuberculin skin tests and/or residual TB lesions in pretransplant chest X-ray) and the intensity of immunosuppression (the use of antilymphocyte antibodies, type of maintenance immunosuppression, and intensification of immunosuppressive therapy for allograft rejection). Recipient’s age, dialysis, diabetes mellitus, chronic liver disease, hepatitis C virus infection, and previous transplantation are other known risk factors for developing TB after transplantation. While TB may be donor transmitted or community acquired, it usually develops at a latent infection site in the recipient, especially in Western countries, where its prevalence is low. Pretransplant prevention efforts will improve transplant outcomes and avoid the complications associated with posttransplant diagnosis and treatment.
KeywordsMycobacterial infections Tuberculosis Transplantation
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