Latent tuberculosis screening and treatment in solid organ and hematopoietic stem cell transplant candidates and recipients

Purpose of review Tuberculosis disease (TBD) has high mortality in transplant recipients. This review evaluates the current evidence for latent tuberculosis infection (LTBI) screening and treatment in solid organ transplant (SOT) and hematopoietic stem cell transplant recipients (HCST). Recent findings Untreated LTBI still poses a significant risk in transplant recipients, with reactivation to TBD leading to high mortality rates. Currently available methods to test for LTBI (interferon-gamma release assays and tuberculin skin tests) can have low predictive value for determining who will progress from LTBI to TBD in transplant. Tuberculosis preventive therapy (TPT) is recommended for those with a positive LTBI screening test. Evidence indicates that short-course, rifamycin-based TPT regimens are associated with less hepatoxicity and improved treatment completion compared to isoniazid. In the transplant population, however, drug-drug interactions limit their use, so isoniazid preventive therapy remains the preferred regimen. Several recent studies have evaluated moxifloxacin as a potential TPT regimen in transplant, but this regimen has not yet been incorporated into guidelines. The timing of LTBI treatment can differ for SOT versus HSCT. Summary While comprehensive LTBI screening and TPT are critical for reducing the risk of TBD, future research should aim to optimize LTBI diagnostic tools and therapeutic regimens to enhance the efficacy of LTBI diagnostics and minimize TPT side effects and drug-drug interactions in the transplant population.