title: Challenging issues in tuberculosis in solid organ transplantation.
abstract: Solid organ transplant (SOT) recipients are at risk for opportunistic infections including tuberculosis. Although guidelines on the management of latent tuberculosis and active tuberculosis are available, there remain a number of clinical areas with limited guidance. We discuss challenges in the diagnosis, management, and treatment of latent and active tuberculosis in SOT candidates and recipients who reside in low-tuberculosis-prevalence areas. We discuss the diagnosis of latent tuberculosis in SOT candidates/recipients using tuberculin skin tests and interferon-γ release assays and risk stratification of SOT candidates/recipients that would identify individuals at high risk for latent tuberculosis despite negative test results. Through a careful review of posttransplant tuberculosis cases, we identify a history of treated tuberculosis in SOT recipients as a risk factor for development of posttransplant active tuberculosis. Finally, we include comparisons of recommendations by several large transplant organizations and identify areas for future research.
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: David J
authors.initials: DJ
authors.lastname: Horne
authors.forename: Masahiro
authors.initials: M
authors.lastname: Narita
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Spitters
authors.forename: Soumya
authors.initials: S
authors.lastname: Parimi
authors.forename: Sherry
authors.initials: S
authors.lastname: Dodson
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014180:Transplantation / Q000009:adverse effects*; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
keywords: solid organ transplant; tuberculosis
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