Subramanian Aruna K
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA.
Curr Opin Infect Dis. 2014 Aug;27(4):316-21. doi: 10.1097/QCO.0000000000000082.
Tuberculosis (TB) infection in solid organ transplant recipients poses unique diagnostic and treatment challenges. Recent guidelines for prevention of donor-derived TB and updates on TB diagnostics and treatment in the transplant setting are reviewed as follows.
Prevention of donor-derived TB can be optimized by careful screening of donors with risk factors for TB, with effort taken to rule out active TB in the donor, and targeted treatment of recipients. However, transmission may still occur, especially through lung allografts, given limitations of screening tests and treatment strategies. Diagnostics for latent tuberculosis infection are limited in sensitivity and have a relatively low predictive value for development of active TB. Treatment options for latent and active TB carry risks that are still being elucidated in transplant patients, such as a dysregulated inflammatory response manifested by immune reconstitution syndrome.
More sensitive diagnostics in deceased donors are needed to quantify the risk of TB transmission and the risk of progression to active tuberculosis in those with latent tuberculosis infection prior to transplant. Novel TB therapies of shorter duration with less toxicity for both latent and active TB will be of great benefit to transplant patients.
实体器官移植受者的结核病（TB）感染带来了独特的诊断和治疗挑战。以下对近期预防供体源性结核病的指南以及移植环境中结核病诊断和治疗的更新情况进行综述。
通过仔细筛查有结核病风险因素的供体、努力排除供体中的活动性结核病以及对受者进行针对性治疗，可以优化预防供体源性结核病。然而，鉴于筛查试验和治疗策略的局限性，传播仍可能发生，尤其是通过肺移植。潜伏性结核感染的诊断方法敏感性有限，对活动性结核病发展的预测价值相对较低。潜伏性和活动性结核病的治疗选择存在风险，在移植患者中仍有待阐明，例如免疫重建综合征表现出的炎症反应失调。
需要在已故供体中采用更敏感的诊断方法，以量化移植前潜伏性结核感染患者的结核病传播风险和进展为活动性结核病的风险。对潜伏性和活动性结核病疗程更短、毒性更小的新型结核病疗法将对移植患者大有裨益。
