Latent tuberculosis infection and renal transplantation - Diagnosis and management

Abstract

Background: Tuberculosis (TB) continues to be the commonest infectious disease cause of death worldwide. Tuberculosis is an important infectious disease cause of morbidity and death in renal transplant recipients. Tuberculosis can also cause loss of kidney allograft.

Objectives: The purpose of this viewpoint is to highlight the issues related to prevention, diagnosis and treatment of tuberculosis in renal transplant recipients.

Methods: The PubMed database was searched for publications and guidelines on diagnosis and management of LTBI in renal transplantation. Publications on renal allograft recipients with LTBI and TB in post-operative period were also analysed. Specialist Society guidelines were also used.

Findings: Tuberculosis is one of the most important infectious disease-related causes of morbidity and death in transplant recipients. LTBI in allograft recipients continues to be a clinical management problem. It can occur either from donor kidney or from endogenous reactivation of latent tuberculosis infection or from acquiring new Mycobacterium tuberculosis infection. Tuberculosis can also cause loss of kidney allograft.

Conclusions: Kidney transplantation is now universally performed in high and low Tuberculosis endemic countries. A high index of awareness of the possibility of TB disease or LTBI is required prior to renal transplant aligned to reduce renal allograft damage, morbidity and death due to tuberculosis. WHO Management recommendations for LTBI screening and treatment should be followed.

Keywords: Allograft; Immune suppression; Interferon gamma assay; Latent tuberculosis infection (LTBI); Renal transplantation; Tuberculin skin test.