Abad, Cybéle Lara R.

AbstractBackgroundMycobacterium tuberculosis (TB) is common worldwide, but is rarely reported after hematopoietic transplantation (HSCT). We reviewed all TB cases among HSCT since 2010 to provide an update on its epidemiology, clinical presentation, management and outcome.MethodsSeveral databases were reviewed from January 1, 2010 to June 30, 2018 using key words tuberculosis and hematopoietic transplantation.ResultsThe 47 cases of TB were reported during the study period. The highest TB frequency was reported from India (2.9%), with a median frequency of 2% (range, 0.18%‐2.9%). The majority were recipients of allogeneic transplants (45/47, 95.7%). Pulmonary TB was the most common clinical presentation (20/47, 42.6%). The median time to clinical presentation was 4.6 (range, 3‐12.9) and 2.4 (range, 0.6‐5) months, based on cohort data and case reports, respectively. Fever was reported in 87.5% (14/16) of patients. First‐line quadruple drug therapy was frequently used (29/35, 82.9%), with a median length of 12 and 9 months for cohorts and case reports, respectively. All‐cause and attributable mortality was 27.6% (13/47), and 8.5% (4/47), respectively.ConclusionsMycobacterium tuberculosis presents early after HSCT, most commonly as fever. A high index of suspicion is needed for early diagnosis and treatment, to prevent TB‐attributable mortality.

AbstractBackgroundMycobacterium tuberculosis may be transmitted via the allograft to cause a morbid and potentially fatal infection after solid organ transplantation (SOT). We reviewed all reported cases of donor‐derived tuberculosis (DDTB) to provide an update on its epidemiology, clinical course, and outcome after SOT.MethodsMEDLINE, OVID, and EMBASE were reviewed from its inception until December 31, 2016 using key words donor‐derived infection, tuberculosis and solid organ transplant or transplantation.ResultsWe retrieved 36 cases of proven (n = 17), probable (n = 8), and possible (n = 11) DDTB among 16 lung, 13 kidney, 6 liver, and 1 heart recipients. Most patients were male (21/35, 60%) with median age of 48 (range 23‐68) years. Median time to clinical presentation or diagnosis was 2.7 months (range 0.2‐29). The most common donor risk factor was residence in a TB‐endemic area (13/28, 46.4%). Fever was the most frequent presenting symptom (20/36, 56.5%). Diagnosis of tuberculosis was mostly made via AFB smear or mycobacterial culture (30/36, 83.3%). Allograft involvement was expectedly common; there were almost equal proportions of pulmonary (36%), extra‐pulmonary (28%) and disseminated (36%) cases. All cases of pulmonary TB were identified only among lung transplant recipients. The median duration of TB treatment was 10.5 (range 3‐24) months. Graft loss occurred in four (4/22, 18.2%) patients. All‐cause mortality was 25% (9/36); four of nine deaths were attributed to TB.ConclusionsDonor‐derived TB presents early after SOT, most commonly as fever, and carries a high mortality risk. Donors should be screened, with particular attention to TB risk factors. Fever during the early post‐operative period should prompt a thorough evaluation for DDTB in endemic regions and among patients with “at‐risk” donors.

Abstract Background Mycobacterium tuberculosis ( TB ) is a common pathogen worldwide, and it may cause significant infection after solid organ transplantation ( SOT ). We reviewed all reported TB cases to provide an update on its epidemiology, clinical presentation, management, and outcome after SOT . Methods MEDLINE , EMBASE , and OVID were reviewed from January 1, 1998, to December 31, 2016, using keywords tuberculosis and solid organ transplant or transplantation. Results There were 187 publications reporting 2082 cases of TB among kidney (n = 1719), liver (n = 253), heart (n = 77), lung (n = 25), and kidney‐pancreas (n = 8) recipients. Among cohort studies, the median incidence was 2.37% (range, 0.05%‐13.27%) overall. Most TB disease was considered reactivation of latent infection, occurring beyond the first year after SOT . Early‐onset cases were seen among donor‐derived TB cases. Fever was the most common symptom. Radiologic findings were highly variable. Extrapulmonary and disseminated TB occurred 29.84% and 15.96%, respectively. Multidrug‐resistant TB was rare. Treatment using 4 or 5 drugs was commonly associated with hepatotoxicity and graft dysfunction. All‐cause mortality was 18.84%. Conclusions This large review highlights the complexity of TB after SOT . Reactivation TB , donor‐transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction.

The epidemiology of infections after living donor liver transplantation (LDLT) is limited. We aimed to study the epidemiology and risk factors of infections after LDLT. The medical records of 223 adult patients who underwent LDLT from January 1, 2000 to August 31, 2015 were reviewed for all infections occurring up to 1 year. We estimated the cumulative incidence of infection using the Kaplan‐Meier product limit method. Risk factors were analyzed with time‐dependent Cox regression modeling. The majority of patients were Caucasian (94.6%) and male (64.6%), and the median age at transplantation was 55 years. The most common indication for transplantation was primary sclerosing cholangitis (37.7%). A total of 122 patients developed an infection during the follow‐up period (1‐year cumulative event rate of 56%), with the majority (66%) of these occurring within 30 days after transplantation.Enterococcus sp. was the most frequent pathogen identified. Multivariate analysis showed that increased Model for End‐Stage Liver Disease (MELD) score (per 10‐point change: hazard ratio [HR], 1.59), history of recurrent infections prior to transplant (HR, 2.01), Roux‐en‐Y anastomosis (HR, 2.37), increased log‐number of packed red blood cell transfusions (HR, 1.39), and biliary complications (HR, 4.26) were independently associated with a higher risk of infection. Infections occur commonly after LDLT, with most infections occurring early and being related to the hepatobiliary system. Higher MELD scores, the type of biliary anastomosis, presence of biliary complications, and prior pretransplant infections are independently associated with a higher risk for infections.Liver Transplantation 23 465–4772017 AASLD.