Table 4.
Major guideline recommendations on LTBI screening and treatment in transplant donors
| Donor-Derived Tuberculosis Guidelines | [43] | [2] | [24] | [3] |
|---|---|---|---|---|
| Applicable population(s) | All SOT | All SOT | Kidney transplant only | All SOT |
| Which donors to routinely screen for latent tuberculosis | All donors | Not mentioned | Not mentioned | Living donors only |
| Routine diagnostic testing for latent tuberculosis | ||||
| Living donors | ||||
| TST | Yes (cutoff using CDC guidelines) | Not mentioned | Not mentioned | Yes |
| IGRA | Yes (alternative to TST) | Feasible, but the best choice is unclear | Not mentioned | Not mentioned |
| Contraindicated donors | (i) Active tuberculosis; (ii) well-founded suspicion of active tuberculosis |
(i) Active tuberculosis | Not mentioned | (i) Active tuberculosis as well as a well-founded suspicion of active tuberculosis; (ii) residual pulmonary lesions in the donor for lung transplant |
| Routine diagnostic testing for latent tuberculosis | ||||
| Deceased donors | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| Treatment | ||||
| Living donors | Latent tuberculosis treatment in the recipient if a donor is TST positive, had recent exposure to active tuberculosis, or had radiographic evidence of untreated prior tuberculosis. Latent tuberculosis treatment should be considered prior to organ donation, especially for TST or IGRA converters |
For living donors, the benefit of prophylactic chemotherapy to reduce the risk of tuberculosis transmission is uncertain | Not mentioned | Treatment of latent tuberculosis must be administered to recipients of an organ whose donor has a history of or data that suggest untreated tuberculosis |
| Treatment | ||||
| Deceased donors | Latent tuberculosis treatment in the recipient if a donor has a history of TST positive (but untreated), had recent exposure to active tuberculosis or had radiographic evidence of untreated tuberculosis | If latent tuberculosis is thought to be present in a deceased donor, the recipient of the lung transplant should be treated for latent tuberculosis | Not mentioned | Latent tuberculosis treatment must be administered to recipients of an organ whose donor has a history of or data that suggest untreated tuberculosis |
Abbreviations: CDC, Centers for Disease Control and Prevention; IGRA, interferon-γ release assay; LTBI, latent tuberculosis infection; SOT, solid organ transplant; TST, tuberculin skin test.