title: Mycobacterium tuberculosis in solid organ transplantation: incidence before and after expanded isoniazid prophylaxis.
abstract: BACKGROUND
  The risk of tuberculosis is increased in solid organ transplantation. Rates remain high in developed and developing countries. We developed protocols to better identify transplant recipients at risk of tuberculosis and initiate interventions to prevent tuberculosis.
  
  
  OBJECTIVE
  Report tuberculosis incidence in solid-organ transplant recipients and the results of expanded isoniazid prophylaxis in deceased-donor renal transplantation.
  
  
  METHODS
  Retrospective cohort study, comparing two time periods.
  
  
  METHODS
  Large transplantation center in a WHO-medium endemicity country for tuberculosis.
  
  
  METHODS
  In a cohort of all solid-organ transplant recipients performed between 2003 and 2012, tuberculosis-free transplantation follow-up is used for incidence calculation. Rates of tuberculosis in renal transplant recipients are compared before and after implementation of expanded isoniazid prophylaxis.
  
  
  METHODS
  Active tuberculosis post-transplantation.
  
  
  RESULTS
  Of 1966 solid-organ transplant recipients (kidney: 1391, liver: 426, heart: 114, lung: 35), 20 recipients (1.02%) developed tuberculosis. Twelve cases (60%) developed tuberculosis within one year of transplantation. The incidence was 248 cases per 100 000 transplant-years. The proportion of transplant recipients (incidence of tuberculosis per 100 000 transplant-years) for specific organs were kidney 0.58% (127), liver 1.88% (594), heart: 1.75% (570), and lung 5.71% (4750). In the survival analysis, lung transplant recipients had significantly higher rates of tuberculosis compared to recipients of kidneys from living donors (P=.0001) with a rate ratio of 45.3 (95% CI: 7-313). Mortality was 5% among tuberculosis patients. After implementing expanded isoniazid prophylaxis among deceased-donor kidney recipients, no tuberculosis occurred in 177 recipients, compared to 3 out of 155 (2%) recipients before implementation.
  
  
  CONCLUSIONS
  Rates of tuberculosis among our solid transplant recipients are decreasing. Universal iso-niazid prophylaxis in transplant recipients could reduce transplant-associated tuberculosis in endemic areas.
  
  
  CONCLUSIONS
  Donor data on tuberculosis exposure and prevention and tuberculosis prevention efforts before referral to our center are not available for all patients.
authors.affiliation: Dr. Suad Mohamed Al-Mukhaini, Sur Hospital Medicine,, South Sharqia,, PO Box 955 Sur, 411, Oman, T: 968 25561100,, F: 968 25561561, almukhainism@gmail.com, ORCID: http://orcid.org/0000-0003-0646-4378.
authors.forename: Suad Mohamed
authors.initials: SM
authors.lastname: Al-Mukhaini
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Eid
authors.forename: Fatima
authors.initials: F
authors.lastname: Alduraibi
authors.forename: Hanan Ibrahim
authors.initials: HI
authors.lastname: Hakami
authors.forename: Haifa Al
authors.initials: HA
authors.lastname: Talhi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shoukri
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Ahmed
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ahmed
authors.forename: Abdulrahman A
authors.initials: AA
authors.lastname: Alrajhi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D066027:Transplant Recipients; D014376:Tuberculosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid