title: Treating tuberculosis in solid organ transplant recipients.
abstract: OBJECTIVE
  To summarize recent findings in the management of active tuberculosis (TB) in solid organ transplant (SOT) recipients.
  
  
  RESULTS
  Mycobacterium tuberculosis causes substantial morbidity and mortality in SOT recipients. According to the literature, transplantation might not be an absolute contraindication for patients with active TB. Although the use of rifampin, resulting in the decreased levels of calcineurin inhibitors, might lead to rejection, studies showed that rifampin-based regimens did not appear to be associated with post-TB rejection or mortality. Nevertheless, judicious adjustment and close monitoring of immunosuppressant levels during concurrent rifampin use for patients with active TB are needed. TB-associated immune reconstitution syndrome occurred in 14% of SOT recipients; liver transplantation, cytomegalovirus infection, and rifampin use are identified risk factors for the development of immune reconstitution syndrome.
  
  
  CONCLUSIONS
  Patients with active TB might be able to undergo transplantation if indicated. Rifampin-based regimen can be considered in the treatment of TB in SOT recipients. In addition to HIV-positive patients, immune reconstitution syndrome also occurs in SOT recipients, and deserves the recognition by primary care physicians to avoid unnecessary management.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D018890:Chemoprevention; D000075202:Contraindications; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D016377:Organ Transplantation / Q000009:adverse effects*; D012293:Rifampin / Q000008:administration & dosage; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000276:immunology*
chemical_list: D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D012293:Rifampin