Screening for TB will benefit kidney transplant patients from high-risk countries



Patients from high-risk countries should be screened for tuberculosis prior to renal transplants, according to Monash research published in Nephrology .

Tuberculosis (TB) is one of the most common infections globally, with around one quarter of the world’s population infected. Fortunately the vast majority of patients have latent infection, and never develop symptoms.

“Active (symptomatic) TB is usually caused by the reactivation of latent infection, and immune suppression increases the risk of reactivation,” said senior author Dr Ben Rogers, a Monash Health infectious disease physician and researcher at Monash University’s Centre for Inflammatory Diseases.

“In the transplant population, TB most commonly arises due to reactivation caused by immunosuppressive medications.”

Dr Rogers said TB is a serious infection in kidney transplant recipients, associated with high mortality.

In Australia there are no formal guidelines for latent TB screening of transplant patients.

“Our findings suggest for the first time in Australia that screening and treatment of renal transplant recipients born in high incidence countries is an important preventive measure,” Dr Rogers said.

The study retrospectively reviewed 660 Monash Medical Centre renal transplantation patients from 2005 to 2014.

“We found that individuals born in high TB risk countries had a much higher incidence of active TB, and up to 16 per cent of our renal transplant patients may be at risk according to their birth countries,” said Dr Nastaran Rafiei, lead author and Monash Health infectious diseases registrar.

Although the number of individuals in the cohort who developed active TB following transplantation was low, all had notably difficult treatment courses and all had disease involving the lungs and were at risk of transmitting infection in the community.

“The World Health Organization, as well as many national transplant committees have guidelines for the management of latent TB in organ transplant recipients, but such screening is not currently part of Australian renal transplant guidelines,” Dr Rafiei said.

“We don’t have protocols or a uniform approach to TB screening for renal transplant recipients, probably because of the very low rate of TB in Australia.”

Dr Rafiei said she hopes these findings will inform the development of local and national guidelines.