Tuberculosis can be a serious opportunistic infection in solid organ transplant recipients, especially in countries with high levels of endemic infection.


Features of tuberculosis in solid organ transplant recipients:

(1) disseminated infection is associated with a high mortality rate

(2) allograft loss due to rejection may occur while receiving antituberculosis therapy

(3) extrapulmonary disease occurs frequently

(4) antituberculous agents may interact with immunosuppressive drugs

(5) antituberculous agents can have serious side effects


Indications for isoniazid prophylaxis in solid organ transplant recipients:

(1) tuberculin reactivity >= 5 mm before transplantation

(2) newly infected person (recent conversion of tuberculin skin test to positive)

(3) patients with the following findings, regardless of tuberculin skin reactivity

(3a) radiographic evidence of old active tuberculosis and no prior prophylaxis

(3b) history of inadequately treated tuberculosis

(3c) close contact with an infectious patient

(3d) receipt of an allograft from a donor with a history of untreated tuberculosis

(3e) receipt of an allograft from a donor with tuberculin reactivity without adequate prophylaxis


Frequency of clinically significant hepatotoxicity due to isoniazid:

(1) 2.5% in renal transplant recipients

(2) 4.5% in heart and lung transplant recipients

(3) 41% in liver transplant recipients


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