Solid Organ Transplantation Among Transplant Candidates With TB Disease

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-04-03 DOI:10.1111/ctr.70528

Cybele Lara R. Abad, Alex Zimmet, Aruna K. Subramanian

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Abstract

Background

Deferral of solid organ transplantation (SOT) in recipients with tuberculosis (TB) disease (active TB) is recommended until anti-tuberculosis treatment (ATT) is completed. However, SOT is often urgent, and there are instances where SOT cannot be safely delayed.

Methods

We report two cases with TB disease who were transplanted before completion of ATT in our institution and searched PubMed, EMBASE, and MEDLINE databases from inception to August 2025, to retrieve all other published cases of Mycobacterium tuberculosis among SOT candidates with active TB disease at time of transplantation.

Results

Sixty-four detailed cases were identified while two cohort studies had aggregated data on 101 cases of TB disease among kidney transplant (KT) candidates. The majority of cases were liver transplant (LT) candidates (60/64, 93.7%); the rest were heart (2/64), kidney (1/64), or lung (1/64) candidates. About half of LT candidates were urgently transplanted because of ATT induced hepatic failure (35/60, 58.3%). Among LT candidates, pulmonary tuberculosis was most common (39/60, 65%) followed by extrapulmonary (EPTB) (17/60, 28.3%), and disseminated TB (4/60, 6.7%). ATT was started prior to transplantation in 44/60 (73.3%) candidates, while 16/60 (26.7%) were started after SOT. The majority (40/44, 90.9%) were on first line therapy, with transplantation occurring a median of 54.5 (range 2–180) days after starting ATT. Many ATT regimens were modified in the post-transplant phase (31/44, 70.4%). Of nine mortalities among LT recipients, only one was directly attributable to TB disease. For both cohort studies on KT candidates, EPTB was the most common form of TB disease (44/71 and 26/30). ATT was taken a median of 3.8 and 3 months, respectively, prior to SOT. All continuation phase posttransplant ATT were rifampicin-sparing with median duration of 12.27 and 14 months, respectively. There were no deaths attributable to TB disease.

Conclusions

Favorable outcomes after SOT are feasible despite TB disease and incomplete pre-transplant anti-TB treatment. The urgent need for a life-saving transplant procedure should be weighed against the risks of transplantation in a patient with active tuberculosis. Completion of at least 2-month intensive first-line TB treatment (e.g., isoniazid, rifampicin, pyrazinamide, ethambutol, [HRZE]) is recommended with use of a rifamycin-based regimen to optimize sterilization. Although rifamycins are preferred for treatment, a rifampicin-sparing regimen may be more manageable post-transplantation to avoid drug–drug interactions, especially if longer courses of treatment are used.

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肺结核患者的实体器官移植

背景：建议结核（TB）疾病（活动性TB）受者推迟进行实体器官移植（SOT），直到完成抗结核治疗（ATT）。然而，SOT通常是紧急的，并且在某些情况下，SOT不能安全地延迟。方法：我们报告了两例在我院ATT完成前进行移植的结核病患者，并检索了PubMed， EMBASE和MEDLINE数据库，从建立到2025年8月，检索移植时伴有活动性结核病的SOT候选人中所有其他已发表的结核分枝杆菌病例。结果：64例详细病例被确定，而两项队列研究汇总了101例肾移植（KT）候选者中结核病的数据。以肝移植（LT）候选人居多（60/64,93.7%）；其余为心脏（2/64）、肾脏（1/64）或肺（1/64）候选。约一半的肝移植候选者因ATT引起的肝功能衰竭而紧急移植（35/60,58.3%）。在LT候选者中，肺结核最常见（39/60,65%），其次是肺外结核（EPTB）（17/60, 28.3%）和弥散性结核（4/60,6.7%）。44/60（73.3%）的患者在移植前开始ATT，而16/60（26.7%）的患者在SOT后开始ATT。大多数患者（40/44,90.9%）接受了一线治疗，在ATT开始后的中位54.5天（范围2-180天）进行了移植。许多ATT方案在移植后阶段进行了修改（31/44,70.4%）。在接受肝移植者的9例死亡中，只有1例直接归因于结核病。在两项关于KT候选药物的队列研究中，EPTB是最常见的结核病形式（44/71和26/30）。在SOT前，ATT的中位时间分别为3.8个月和3个月。移植后所有延续期ATT均为利福平节约期，中位持续时间分别为12.27个月和14个月。没有可归因于结核病的死亡。结论：尽管存在结核病和不完全的移植前抗结核治疗，SOT术后的良好结果是可行的。对挽救生命的移植手术的迫切需要应该与活动性肺结核患者的移植风险进行权衡。建议完成至少2个月的一线结核病强化治疗（例如异烟肼、利福平、吡嗪酰胺、乙胺丁醇[HRZE]），并使用利福霉素为基础的方案，以优化灭菌。虽然利福霉素是首选的治疗方案，但移植后保留利福霉素的方案可能更易于管理，以避免药物相互作用，特别是如果使用较长的疗程。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.