title: The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement.
abstract: Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-γ based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking.
authors.affiliation: Dept of Pneumology, Elias Emergency University Hospital and Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Bumbacea
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Arend
authors.forename: Fusun
authors.initials: F
authors.lastname: Eyuboglu
authors.forename: Jay A
authors.initials: JA
authors.lastname: Fishman
authors.forename: Delia
authors.initials: D
authors.lastname: Goletti
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ison
authors.forename: Christine E
authors.initials: CE
authors.lastname: Jones
authors.forename: Beate
authors.initials: B
authors.lastname: Kampmann
authors.forename: Camille N
authors.initials: CN
authors.lastname: Kotton
authors.forename: Christoph
authors.initials: C
authors.lastname: Lange
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Heather
authors.initials: H
authors.lastname: Milburn
authors.forename: Michele I
authors.initials: MI
authors.lastname: Morris
authors.forename: Elmi
authors.initials: E
authors.lastname: Muller
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Anoma
authors.initials: A
authors.lastname: Nellore
authors.forename: Hans L
authors.initials: HL
authors.lastname: Rieder
authors.forename: Urban
authors.initials: U
authors.lastname: Sester
authors.forename: Nicole
authors.initials: N
authors.lastname: Theodoropoulos
authors.forename: Dirk
authors.initials: D
authors.lastname: Wagner
authors.forename: Martina
authors.initials: M
authors.lastname: Sester
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D018890:Chemoprevention; D032921:Consensus; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000276:immunology; D009169:Mycobacterium tuberculosis / Q000276:immunology; D017410:Practice Guidelines as Topic; D014180:Transplantation / Q000379:methods*; D019737:Transplants / Q000382:microbiology; D014376:Tuberculosis / Q000276:immunology / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents; D007166:Immunosuppressive Agents