Table 1.

Characteristics of Tuberculosis in Solid Organ Transplant Recipients

Characteristic	SOT Recipients	Non-SOT Individuals
Organ involvement	Extrapulmonary and disseminated tuberculosis more common (45%–67% of cases) [5, 6, 8] May occur in uncommon sites of tuberculosis involvement including kidneys, gastrointestinal tract, joints, and skin	Any extrapulmonary tuberculosis in 32% of US tuberculosis cases in 2011 [11]
Risk factors	In addition to standard tuberculosis risk factors: T-cell–depleting antibodies, higher intensity immunosuppression, liver disease, renal insufficiency and hemodialysis, diabetes mellitus, and increased recipient age [3, 7, 8, 12, 13] Lung transplant recipients at higher risk for tuberculosis in most studies [5, 7]	History of tuberculosis, latent tuberculosis, or tuberculosis exposures; fibrotic changes on chest radiograph, silicosis, HIV infection, country of origin, and social risk factors such as homelessness, incarceration, and injection drug use [14]
Symptoms	Symptoms may be nonspecific including fever, weight loss, night sweats Fever seen in most patients and tuberculosis should be considered in SOT recipients with fever of unknown origin [6]	In pulmonary tuberculosis cough is present in 75% [15] Constitutional symptoms include fever (50%–60%), weight loss, night sweats
Imaging	Chest imaging findings include focal infiltrates (40%), miliary pattern (22%), pleural effusions (13%), and nodules (5%) Cavities unusual (4%) [6]	Upper lobe infiltrates and cavities characteristic for pulmonary tuberculosis Atypical appearances (lower lobe disease, lymphadenopathy) more common in children and HIV-infected adults
Time to diagnosis	Often delayed due to extrapulmonary involvement, atypical presentations and imaging, and coinfections [6–8, 16] Lack of obvious tuberculosis risk factors may increase time to diagnosis: liver transplant recipients born outside the US were diagnosed with tuberculosis sooner than US born [17]	Delays in tuberculosis diagnosis occur in extrapulmonary tuberculosis, sputum-smear-negative disease, and individuals with poor healthcare access [11]
Mortality	Overall mortality approximately 30%; higher mortality due to immunosuppression and comorbidities [6, 17] Increased mortality associated with delayed diagnosis, disseminated disease, prior organ rejection, and receipt of anti–T-cell antibodies [6, 17]	US tuberculosis-related mortality <5% Increased mortality associated with age, comorbidities, delays in treatment, increased disease burden [18]

Abbreviations: HIV, human immunodeficiency virus; SOT, solid organ transplant.