The prevention and treatment of tuberculosis in transplantation

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Abstract
Unusual clinical manifestations, high incidence of disseminated disease, and a mortality rate ranging from 25 to 40% characterize Mycobacterium tuberculosis infection in organ transplant recipients. The most controversial issues regarding the management of tuberculosis after transplantation pertain to the rationale and indications for isoniazid chemoprophylaxis and the use of rifampin-containing antituberculosis regimens for therapy. The use of rifampin-containing antituberculosis regimens warrants close monitoring of immunosuppressive drug levels, given a high risk of rejection, allograft loss, and mortality in the patients experiencing rejection. Factors portending a high risk of M. tuberculosis in transplant recipients have been identified, and chemoprophylaxis in these patients is advisable. A vast majority of the transplant recipients (nearly 75%) are, however, anergic; an approach to the effective prevention of tuberculosis in these patients remains undefined.