Korean J Transplant.  2021 Dec;35(4):208-217. 10.4285/kjt.21.0033.

Mycobacterial infections in solid organ transplant recipients

• Rashid HU
• Salma Begum NA
• Kashem TS

• KMID: 2523670
• DOI: http://doi.org/10.4285/kjt.21.0033

Abstract

Mycobacterium tuberculosis(MTB) infection in solid organ transplant (SOT) recipients remains a major challenge for physicians and surgeons. Active tuberculosis (TB) is associated with increased morbidity and mortality in SOT recipients. MTB usually develops after transplantation in a recipient with latent TB infection (LTBI) before transplantation and may also be transmitted from the donor or acquired from the community. Therefore, screening for LTBI in donors and recipients before transplantation is very important in preventing active disease after transplantation. This review article is based on recently published data, case series, and expert recommendations. We reviewed updated information about the epidemiology, diagnosis, and treatment of latent and active TB before and after transplantation. We also reviewed recent treatments for multidrug-resistant TB.

Keyword

Mycobacterium tuberculosis; Latent tuberculosis infection; Solid organ transplantation; Multidrug-resistant tuberculosis

Reference

1. World Health Organization. 2021. Tuberculosis (fact sheets) [Internet]. World Health Organization;Geneva: Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis. cited 2021 Dec 21.

2. Currie AC, Knight SR, Morris PJ. 2010; Tuberculosis in renal transplant recipients: the evidence for prophylaxis. Transplantation. 90:695–704. DOI: 10.1097/TP.0b013e3181ecea8d. PMID: 20647975.

3. Muñoz P, Rodríguez C, Bouza E. 2005; Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis. 40:581–7. DOI: 10.1086/427692. PMID: 15712081.

4. Singh N, Paterson DL. 1998; Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis. 27:1266–77. DOI: 10.1086/514993. PMID: 9827281.

5. Centers for Disease Control and Prevention. 2016. World TB day [Internet]. Centers for Disease Control and Prevention;Atlanta, GA: Available from: https://www.cdc.gov/tb/worldtbday/history.htm. cited 2021 Dec 21.

6. World Health Organization. 2021. Global tuberculosis report 2021. World Health Organization;Geneva: Available from: https://www.who.int/publications/i/item/9789240037021. cited 2021 Dec 21.

7. Aubert O, Yoo D, Zielinski D, Cozzi E, Cardillo M, Dürr M, et al. 2021; COVID-19 pandemic and worldwide organ transplantation: a population-based study. Lancet Public Health. 6:e709–19. DOI: 10.1016/S2468-2667(21)00200-0. PMID: 34474014. PMCID: PMC8460176.

8. Sakhuja V, Jha V, Varma PP, Joshi K, Chugh KS. 1996; The high incidence of tuberculosis among renal transplant recipients in India. Transplantation. 61:211–5. DOI: 10.1097/00007890-199601270-00008. PMID: 8600625.

9. Gupta RK, Rosenberg G, Eriksen J, Lipman M, Jackson C, Roy A, et al. 2019; Tuberculosis following renal transplantation in England, Wales and Northern Ireland: a national registry-based cohort study. Eur Respir J. 54:1802245. DOI: 10.1183/13993003.02245-2018. PMID: 31248953.

10. Lopez de Castilla D, Schluger NW. 2010; Tuberculosis following solid organ transplantation. Transpl Infect Dis. 12:106–12. DOI: 10.1111/j.1399-3062.2009.00475.x. PMID: 20002613.

11. Aguado JM, Torre-Cisneros J, Fortún J, Benito N, Meije Y, Doblas A, et al. 2009; Tuberculosis in solid-organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology. Clin Infect Dis. 48:1276–84. DOI: 10.1086/597590. PMID: 19320593.

12. Centers for Disease Control and Prevention (CDC). 2008; Transplantation-transmitted tuberculosis: Oklahoma and Texas, 2007. MMWR Morb Mortal Wkly Rep. 57:333–6. PMID: 18385639.

13. Ison MG, Hager J, Blumberg E, Burdick J, Carney K, Cutler J, et al. 2009; Donor-derived disease transmission events in the United States: data reviewed by the OPTN/UNOS Disease Transmission Advisory Committee. Am J Transplant. 9:1929–35. DOI: 10.1111/j.1600-6143.2009.02700.x. PMID: 19538493.

14. Sundberg R, Shapiro R, Darras F, Jensen C, Scantlebury V, Jordan M, et al. 1991; A tuberculosis outbreak in a renal transplant program. Transplant Proc. 23:3091–2. PMID: 1750089. PMCID: PMC2958521.

15. Jereb JA, Burwen DR, Dooley SW, Haas WH, Crawford JT, Geiter LJ, et al. 1993; Nosocomial outbreak of tuberculosis in a renal transplant unit: application of a new technique for restriction fragment length polymorphism analysis of Mycobacterium tuberculosis isolates. J Infect Dis. 168:1219–24. DOI: 10.1093/infdis/168.5.1219. PMID: 7901287.

16. Torre-Cisneros J, Doblas A, Aguado JM, San Juan R, Blanes M, Montejo M, et al. 2009; Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort. Clin Infect Dis. 48:1657–65. DOI: 10.1086/599035. PMID: 19445585.

17. Torres J, Aguado JM, San Juan R, Andrés A, Sierra P, López-Medrano F, et al. 2008; Hepatitis C virus, an important risk factor for tuberculosis in immunocompromised: experience with kidney transplantation. Transpl Int. 21:873–8. DOI: 10.1111/j.1432-2277.2008.00694.x. PMID: 18482173.

18. Murugesh Anand S, Edwin Fernando M, Srinivasaprasad ND, Sujit S, Thirumalvalavan K. 2020; Tuberculous myositis and cellulitis in a renal transplant recipient. Indian J Tuberc. 67:353–6. DOI: 10.1016/j.ijtb.2019.04.010. PMID: 32825866.

19. Toyokawa N, Kokubu T, Fujioka H. 2008; Mycobacterial tuberculous tenosynovitis of the extensor tendon occurring after liver transplantation: a case report. Hand Surg. 13:37–40. DOI: 10.1142/S0218810408003797. PMID: 18711783.

20. Kim SY, Jung GS, Kim SK, Chang J, Kim MS, Kim YS, et al. 2013; Comparison of the tuberculin skin test and interferon-γ release assay for the diagnosis of latent tuberculosis infection before kidney transplantation. Infection. 41:103–10. DOI: 10.1007/s15010-012-0291-0. PMID: 22802098.

21. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K, et al. 2010; Updated guidelines for using Interferon gamma release assays to detect Mycobacterium tuberculosis infection: United States, 2010. MMWR Recomm Rep. 59:1–25. PMID: 20577159.

22. Mazurek GH, LoBue PA, Daley CL, Bernardo J, Lardizabal AA, Bishai WR, et al. 2001; Comparison of a whole-blood interferon gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection. JAMA. 286:1740–7. DOI: 10.1001/jama.286.14.1740. PMID: 11594899.

23. Sester U, Wilkens H, van Bentum K, Singh M, Sybrecht GW, Schäfers HJ, et al. 2009; Impaired detection of Mycobacterium tuberculosis immunity in patients using high levels of immunosuppressive drugs. Eur Respir J. 34:702–10. DOI: 10.1183/09031936.00013409. PMID: 19386692.

24. Lange B, Vavra M, Kern WV, Wagner D. 2010; Indeterminate results of a tuberculosis-specific interferon-gamma release assay in immunocompromised patients. Eur Respir J. 35:1179–82. DOI: 10.1183/09031936.00122109. PMID: 20436175.

25. Subramanian A, Dorman S. AST Infectious Diseases Community of Practice. 2009; Mycobacterium tuberculosis in solid organ transplant recipients. Am J Transplant. 9 Suppl 4:S57–62. DOI: 10.1111/j.1600-6143.2009.02894.x. PMID: 20070696.

26. Meije Y, Piersimoni C, Torre-Cisneros J, Dilektasli AG, Aguado JM. ESCMID Study Group of Infection in Compromised Hosts. 2014; Mycobacterial infections in solid organ transplant recipients. Clin Microbiol Infect. 20 Suppl 7:89–101. DOI: 10.1111/1469-0691.12641. PMID: 24707957.

27. Rubin RH. Rubin RH, Young LS, Van Furth R, editors. 2002. Infection in the organ transplant recipient. Clinical approach to infection in the compromised host. 4th ed. Springer;Boston, MA: p. 573–679. DOI: 10.1007/0-306-47527-8_17.

28. National Collaborating Centre for Chronic Conditions (UK); Centre for Clinical Practice at NICE (UK). 2011. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. NICE clinical guidelines, No. 117. The guideline: diagnosis and treatment. National Institute for Health and Clinical Excellence (UK);London: Available from: https://www.ncbi.nlm.nih.gov/books/NBK97854/. cited 2021 Dec 21.

29. Kim SH, Lee SO, Park IA, Park SJ, Choi SH, Kim YS, et al. 2010; Diagnostic usefulness of a T cell-based assay for latent tuberculosis infection in kidney transplant candidates before transplantation. Transpl Infect Dis. 12:113–9. DOI: 10.1111/j.1399-3062.2010.00495.x. PMID: 20113458.

30. Lyu J, Lee SG, Hwang S, Lee SO, Cho OH, Chae EJ, et al. 2011; Chest computed tomography is more likely to show latent tuberculosis foci than simple chest radiography in liver transplant candidates. Liver Transpl. 17:963–8. DOI: 10.1002/lt.22319. PMID: 21506252.

31. American Thoracic Society; Centers for Disease Control and Prevention; Infectious Diseases Society of America. 2005; American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States. Am J Respir Crit Care Med. 172:1169–227. DOI: 10.1164/rccm.2508001. PMID: 16249321.

32. Holty JE, Gould MK, Meinke L, Keeffe EB, Ruoss SJ. 2009; Tuberculosis in liver transplant recipients: a systematic review and meta-analysis of individual patient data. Liver Transpl. 15:894–906. DOI: 10.1002/lt.21709. PMID: 19642133.

33. Blumberg HM, Leonard MK Jr, Jasmer RM. 2005; Update on the treatment of tuberculosis and latent tuberculosis infection. JAMA. 293:2776–84. DOI: 10.1001/jama.293.22.2776. PMID: 15941808.

34. Menzies D, Al Jahdali H, Al Otaibi B. 2011; Recent developments in treatment of latent tuberculosis infection. Indian J Med Res. 133:257–66. PMID: 21441678. PMCID: PMC3103149.

35. Jafri SM, Singal AG, Kaul D, Fontana RJ. 2011; Detection and management of latent tuberculosis in liver transplant patients. Liver Transpl. 17:306–14. DOI: 10.1002/lt.22203. PMID: 21384513.

36. Naqvi R, Akhtar S, Noor H, Saeed T, Bhatti S, Sheikh R, et al. 2006; Efficacy of isoniazid prophylaxis in renal allograft recipients. Transplant Proc. 38:2057–8. DOI: 10.1016/j.transproceed.2006.06.010. PMID: 16979998.

37. Aspler A, Long R, Trajman A, Dion MJ, Khan K, Schwartzman K, et al. 2010; Impact of treatment completion, intolerance and adverse events on health system costs in a randomised trial of 4 months rifampin or 9 months isoniazid for latent TB. Thorax. 65:582–7. DOI: 10.1136/thx.2009.125054. PMID: 20627913.

38. Targeted tuberculin testing and treatment of latent tuberculosis infection. 2000; American Thoracic Society. MMWR Recomm Rep. 49:1–51. DOI: 10.15585/mmwr.rr6901a1. PMID: 32053584. PMCID: PMC7041302.

39. Halsey NA, Coberly JS, Desormeaux J, Losikoff P, Atkinson J, Moulton LH, et al. 1998; Randomised trial of isoniazid versus rifampicin and pyrazinamide for prevention of tuberculosis in HIV-1 infection. Lancet. 351:786–92. DOI: 10.1016/S0140-6736(97)06532-X. PMID: 9519950.

40. Mwinga A, Hosp M, Godfrey-Faussett P, Quigley M, Mwaba P, Mugala BN, et al. 1998; Twice weekly tuberculosis preventive therapy in HIV infection in Zambia. AIDS. 12:2447–57. DOI: 10.1097/00002030-199818000-00014. PMID: 9875583.

41. Gordin F, Chaisson RE, Matts JP, Miller C, de Lourdes Garcia M, Hafner R, et al. 2000; Rifampin and pyrazinamide vs isoniazid for prevention of tuberculosis in HIV-infected persons: an international randomized trial. Terry Beirn Community Programs for Clinical Research on AIDS, the Adult AIDS Clinical Trials Group, the Pan American Health Organization, and the Centers for Disease Control and Prevention Study Group. JAMA. 283:1445–50. DOI: 10.1001/jama.283.11.1445. PMID: 10732934.

42. Jasmer RM, Daley CL. 2003; Rifampin and pyrazinamide for treatment of latent tuberculosis infection: is it safe? Am J Respir Crit Care Med. 167:809–10. DOI: 10.1164/rccm.2301002. PMID: 12623855.

43. Sterling TR, Villarino ME, Borisov AS, Shang N, Gordin F, Bliven-Sizemore E, et al. 2011; Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 365:2155–66. DOI: 10.1056/NEJMoa1104875. PMID: 22150035.

44. de Castilla DL, Rakita RM, Spitters CE, Narita M, Jain R, Limaye AP. 2014; Short-course isoniazid plus rifapentine directly observed therapy for latent tuberculosis in solid-organ transplant candidates. Transplantation. 97:206–11. DOI: 10.1097/TP.0b013e3182a94a2f. PMID: 24142036.

45. Knoll BM, Nog R, Wu Y, Dhand A. 2017; Three months of weekly rifapentine plus isoniazid for latent tuberculosis treatment in solid organ transplant candidates. Infection. 45:335–9. DOI: 10.1007/s15010-017-1004-5. PMID: 28276008.

46. Lui SL, Li FK, Choy BY, Chan TM, Lo WK, Lai KN. 2004; Long-term outcome of isoniazid prophylaxis against tuberculosis in Chinese renal transplant recipients. Transpl Infect Dis. 6:55–6. DOI: 10.1111/j.1399-3062.2004.00050.x. PMID: 15225230.

47. Dodani SK, Nasim A, Aziz T, Naqvi A. 2021; The efficacy of isoniazid prophylaxis in renal transplant recipients in a high tuberculosis burden country. Transpl Infect Dis. 23:e13709. DOI: 10.1111/tid.13709. PMID: 34331355.

48. Sud K, Muthukumar T, Singh B, Garg SK, Kohli HS, Jha V, et al. 2000; Isoniazid does not affect bioavailability of cyclosporine in renal transplant recipients. Methods Find Exp Clin Pharmacol. 22:647–9. DOI: 10.1358/mf.2000.22.8.802278. PMID: 11256238.

49. Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D. 2003; Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med. 167:1472–7. DOI: 10.1164/rccm.200206-626OC. PMID: 12569078.

50. Nagai S, Fujimoto Y, Taira K, Egawa H, Takada Y, Kiuchi T, et al. 2007; Liver transplantation without isoniazid prophylaxis for recipients with a history of tuberculosis. Clin Transplant. 21:229–34. DOI: 10.1111/j.1399-0012.2006.00630.x. PMID: 17425750.

51. Benito N, Sued O, Moreno A, Horcajada JP, González J, Navasa M, et al. 2002; Diagnosis and treatment of latent tuberculosis infection in liver transplant recipients in an endemic area. Transplantation. 74:1381–6. DOI: 10.1097/00007890-200211270-00006. PMID: 12451235.

52. Fábrega E, Sampedro B, Cabezas J, Casafont F, Mieses MÁ, Moraleja I, et al. 2012; Chemoprophylaxis with isoniazid in liver transplant recipients. Liver Transpl. 18:1110–7. DOI: 10.1002/lt.23480. PMID: 22645064.

53. Singh N, Wagener MM, Gayowski T. 2002; Safety and efficacy of isoniazid chemoprophylaxis administered during liver transplant candidacy for the prevention of posttransplant tuberculosis. Transplantation. 74:892–5. DOI: 10.1097/00007890-200209270-00029. PMID: 12364876.

54. Stucchi RS, Boin IF, Angerami RN, Zanaga L, Ataide EC, Udo EY. 2012; Is isoniazid safe for liver transplant candidates with latent tuberculosis? Transplant Proc. 44:2406–10. DOI: 10.1016/j.transproceed.2012.07.035. PMID: 23026607.

55. Silva JT, San-Juan R, Fernández-Ruiz M, Aguado JM. 2019; Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation. World J Gastroenterol. 25:3291–8. DOI: 10.3748/wjg.v25.i26.3291. PMID: 31341356. PMCID: PMC6639553.

56. Shankar MS, Aravindan AN, Sohal PM, Kohli HS, Sud K, Gupta KL, et al. 2005; The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis. Nephrol Dial Transplant. 20:2720–4. DOI: 10.1093/ndt/gfi141. PMID: 16188895.

57. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. 2016; Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 63:e147–95. DOI: 10.1093/cid/ciw376. PMID: 27516382. PMCID: PMC6590850.

58. EBPG Expert Group on Renal Transplantation. 2002; European best practice guidelines for renal transplantation. Section IV: long-term management of the transplant recipient. IV.7.2. Late infections. Tuberculosis. Nephrol Dial Transplant. 17 Suppl 4:39–43. PMID: 12091644.

59. al-Sulaiman MH, Dhar JM, al-Khader AA. 1990; Successful use of rifampicin in the treatment of tuberculosis in renal transplant patients immunosuppressed with cyclosporine. Transplantation. 50:597–8. DOI: 10.1097/00007890-199010000-00014. PMID: 2219282.

60. Bumbacea D, Arend SM, Eyuboglu F, Fishman JA, Goletti D, Ison MG, et al. 2012; The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement. Eur Respir J. 40:990–1013. DOI: 10.1183/09031936.00000712. PMID: 22496318.

61. Chang KC, Leung CC, Yew WW, Chan SL, Tam CM. 2006; Dosing schedules of 6-month regimens and relapse for pulmonary tuberculosis. Am J Respir Crit Care Med. 174:1153–8. DOI: 10.1164/rccm.200605-637OC. PMID: 16908866.

62. Buffington GA, Dominguez JH, Piering WF, Hebert LA, Kauffman HM Jr, Lemann J Jr. 1976; Interaction of rifampin and glucocorticoids: adverse effect on renal allograft function. JAMA. 236:1958–60. DOI: 10.1001/jama.1976.03270180034016. PMID: 787563.

63. Paterson DL, Singh N. 1997; Interactions between tacrolimus and antimicrobial agents. Clin Infect Dis. 25:1430–40. DOI: 10.1086/516138. PMID: 9431391.

64. McAllister WA, Thompson PJ, Al-Habet SM, Rogers HJ. 1983; Rifampicin reduces effectiveness and bioavailability of prednisolone. Br Med J (Clin Res Ed). 286:923–5. DOI: 10.1136/bmj.286.6369.923. PMID: 6403136. PMCID: PMC1547305.

65. Modry DL, Stinson EB, Oyer PE, Jamieson SW, Baldwin JC, Shumway NE. 1985; Acute rejection and massive cyclosporine requirements in heart transplant recipients treated with rifampin. Transplantation. 39:313–4. DOI: 10.1097/00007890-198503000-00022. PMID: 3883596.

66. Ngo BT, Pascoe M, Khan D. 2011; Drug interaction between rifampicin and sirolimus in transplant patients. Saudi J Kidney Dis Transpl. 22:112–5. PMID: 21196624.

67. Lefeuvre S, Rebaudet S, Billaud EM, Wyplosz B. 2012; Management of rifamycins- everolimus drug-drug interactions in a liver-transplant patient with pulmonary tuberculosis. Transpl Int. 25:e120–3. DOI: 10.1111/j.1432-2277.2012.01561.x. PMID: 22994607.

68. Vachharajani TJ, Oza UG, Phadke AG, Kirpalani AL. 2002; Tuberculosis in renal transplant recipients: rifampicin sparing treatment protocol. Int Urol Nephrol. 34:551–3. DOI: 10.1023/A:1025693521582. PMID: 14577503.

69. Jha V, Sakhuja V. 2004; Rifampicin sparing treatment protocols in posttransplant tuberculosis. Int Urol Nephrol. 36:287–8. DOI: 10.1023/B:UROL.0000034616.17935.98. PMID: 15368713.

70. Ho CC, Chen YC, Hu FC, Yu CJ, Yang PC, Luh KT. 2009; Safety of fluoroquinolone use in patients with hepatotoxicity induced by anti-tuberculosis regimens. Clin Infect Dis. 48:1526–33. DOI: 10.1086/598929. PMID: 19400686.

71. Yoon HE, Jeon YJ, Chung HW, Shin SJ, Hwang HS, Lee SJ, et al. 2012; Safety and efficacy of a quinolone-based regimen for treatment of tuberculosis in renal transplant recipients. Transplant Proc. 44:730–3. DOI: 10.1016/j.transproceed.2011.12.065. PMID: 22483479.

72. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. 2003; American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 167:603–62. DOI: 10.1164/rccm.167.4.603. PMID: 12588714.

73. Jindani A, Harrison TS, Nunn AJ, Phillips PP, Churchyard GJ, Charalambous S, et al. 2014; High-dose rifapentine with moxifloxacin for pulmonary tuberculosis. N Engl J Med. 371:1599–608. DOI: 10.1056/NEJMoa1314210. PMID: 25337749. PMCID: PMC4233406.

74. Merle CS, Fielding K, Sow OB, Gninafon M, Lo MB, Mthiyane T, et al. 2014; A four-month gatifloxacin-containing regimen for treating tuberculosis. N Engl J Med. 371:1588–98. DOI: 10.1056/NEJMoa1315817. PMID: 25337748.

75. Kirsch S, Sester M. 2012; Tuberculosis in transplantation: diagnosis, prevention, and treatment. Curr Infect Dis Rep. 14:650–7. DOI: 10.1007/s11908-012-0293-1. PMID: 22972591.

76. Lou HX, Shullo MA, McKaveney TP. 2002; Limited tolerability of levofloxacin and pyrazinamide for multidrug-resistant tuberculosis prophylaxis in a solid organ transplant population. Pharmacotherapy. 22:701–4. DOI: 10.1592/phco.22.9.701.34065. PMID: 12066961.

77. Fortún J, Martín-Dávila P, Navas E, Pérez-Elías MJ, Cobo J, Tato M, et al. 2005; Linezolid for the treatment of multidrug-resistant tuberculosis. J Antimicrob Chemother. 56:180–5. DOI: 10.1093/jac/dki148. PMID: 15911549.

78. Wong CF, Fung SL, Yan SW, Lee J, Cheng LC, Chiu CS. 2008; Lung transplantation in Hong Kong: 12 years of experience. Respirology. 13:903–7. DOI: 10.1111/j.1440-1843.2008.01360.x. PMID: 18811889.

79. Di Perri G, Luzzati R, Forni A, Allegranzi B, Cazzadori A, Bonora S, et al. 1998; Fatal primary multidrug-resistant tuberculosis in a heart transplant recipient. Transpl Int. 11:305–7. DOI: 10.1007/s001470050147. PMID: 9704397.

80. Shitrit D, Bendayan D, Saute M, Kramer MR. 2004; Multidrug resistant tuberculosis following lung transplantation: treatment with pulmonary resection. Thorax. 59:79–80. PMID: 14694255. PMCID: PMC1758832.

81. Babar ZU, Nasim A, Kumar S, Nazmi J, Badlani S, Nadeem A, et al. 2021; A case series of multidrug-resistant tuberculosis in renal transplant recipients: challenges in management from a TB endemic country. Transpl Infect Dis. 23:e13659. DOI: 10.1111/tid.13659. PMID: 34057810.

82. Huaman MA, Brawley R, Ashkin D. Multidrug-resistant tuberculosis in transplant recipients: case report and review of the literature. Transpl Infect Dis. 2017; 19:DOI: 10.1111/tid.12672. PMID: 28166377.

83. Chan ED, Laurel V, Strand MJ, Chan JF, Huynh ML, Goble M, et al. 2004; Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 169:1103–9. DOI: 10.1164/rccm.200308-1159OC. PMID: 14742301.

84. Franke MF, Khan P, Hewison C, Khan U, Huerga H, Seung KJ, et al. 2021; Culture conversion in patients treated with bedaquiline and/or delamanid: a prospective multicountry study. Am J Respir Crit Care Med. 203:111–9. DOI: 10.1164/rccm.202001-0135OC. PMID: 32706644. PMCID: PMC7781121.