Prevalence of Active Tuberculosis Infection in Transplant Recipients: A Systematic Review and Meta-Analysis Publisher Pubmed



Mamishi S^{1, 2} ; Pourakbari B¹ ; Moradzadeh M¹ ; Van Leeuwen WB³ ; Mahmoudi S¹
Source: Microbial Pathogenesis Published:2020

Abstract

Introduction: Tuberculosis (TB) is considered as a serious complication of organ transplant; therefore, the detection and appropriate treatment of active TB infection is highly recommended for the reduction of mortality in the future. The aim of this review was to conduct a systematic review and meta-analysis assessing the prevalence of active TB infection in transplant recipients (TRs). Material and methods: Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched up to December 24, 2017. The prevalence of active TB was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 14. Results: The pooled prevalence of post-transplant active TB was estimated 3% [95% CI: 2–3]. The pooled prevalence of active TB in different transplant forms was as follows: renal,3% [95% CI: 2–4]; stem cell transplant (SCT), 1% [95% CI: 0–3]; lung, 4% [95% CI: 2–6]; heart, 3% [95% CI: 2–4]; liver, 1% [95% CI: 1], and hematopoietic stem cell transplant (HSCT), 2% [95% CI: 1–3]. The prevalence of different clinical presentations of TB was as follows: pulmonary TB (59%; 95% CI: 54–65), extra pulmonary TB (27%; 95% CI: 21–33), disseminated TB (15%; 95% CI: 12–19) and miliary TB (8%; 95% CI: 4–13). The pooled prevalence of different diagnostic tests was as follows: chest X-ray, 57% [95% CI, 46–67]; culture, 56% [95% CI, 45–68]; smear, 49% [95% CI, 40–58]; PCR, 43% [95% CI, 40–58]; histology, 26% [95% CI, 20–32], and tuberculin skin test, 19% [95% CI, 10–28]. Conclusion: A high suspicion level for TB, the early diagnosis and the prompt initiation of therapy could increase the survival rates among SOT patients. Overall, renal and lung TRs appear to have a higher predisposition for acquiring TB than other type of recipients. Monitoring of the high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection among TRs especially in endemic areas. © 2019 Elsevier Ltd