ABSTRACT Background Tuberculosis remains a principal cause of morbidity and mortality after kidney transplantation across South and Southeast Asia, where tuberculosis infection is prevalent. India carries one‐quarter of the global tuberculosis burden, yet transplant‐specific guidance for high‐burden settings is scarce. The Indian Society of Organ Transplantation (ISOT) convened a multidisciplinary expert panel to formulate consensus recommendations for the management of tuberculosis infection in kidney transplantation. Methods A multidisciplinary panel undertook a structured, evidence‐informed consensus process, appraising MEDLINE, EMBASE, Scopus, the Cochrane Library, and national tuberculosis program documents. Statements were refined through successive revision rounds, panel discussion at the ISOT Mid‐Term Conference (Bengaluru, May 2026), and confirmation by all authors, preceding executive committee endorsement. Each statement received an evidence level (1–5) and, where actionable, a recommendation strength. Results The panel formulated 36 consensus statements across 11 domains. Routine pre‐transplant screening for tuberculosis infection is endorsed, with exclusion of tuberculosis disease before treatment of tuberculosis infection. The interferon‐gamma release assay (IGRA) is preferred, given confounding of the tuberculin skin test by bacille Calmette–Guérin (BCG) vaccination; a Mycobacterium tuberculosis ‐specific antigen‐based skin test (Cy‐Tb) is an acceptable alternative where IGRA is unavailable or unaffordable. Isoniazid‐based regimens are preferred, as rifampicin reduces calcineurin‐inhibitor exposure; isoniazid resistance, hepatotoxicity, and hepatitis C co‐infection warrant individualized therapy. Conclusion This first India‐specific, society‐endorsed position statement provides context‐adapted recommendations for the management of tuberculosis infection in kidney transplantation and may inform adaptation in other high‐burden settings; prospective multicenter studies are needed. image
Background Recently updated guidelines suggest monthly cytomegalovirus (CMV) cell-mediated immunity (CMI) testing in seropositive (R+) kidney transplant recipients to stratify posttransplant CMV risk and guide prophylaxis. UW Health has protocolized T-cell immunity panel (TCIP) testing since 2023. The purpose was to assess real-world implementation of TCIP testing and the feasibility of this approach. Methods This retrospective cohort study included adult R+ renal transplant (RTX) recipients transplanted March 1, 2023, to April 9, 2025, received lymphocyte depleting induction and completed TCIP testing at 3 months posttransplant. Results Here, 234 patients were eligible for protocolized TCIP testing during the study period, with 160 patients obtaining a TCIP (68.4%). Mean time to TCIP draw was 94 +/- 15.6 days post-RTX. Of those who obtained TCIP, 75 had positive, 57 negative, and 28 with indeterminate results. Significantly more patients with indeterminate TCIP received alemtuzumab induction (8.0% vs. 8.8%vs. 89.3%, p < 0.0001). Positive TCIP facilitated significantly shorter prophylaxis duration (153.8 vs. 172.2 vs. 180.1 days, p = 0.003). WBC were significantly lower among patients with an indeterminate TCIP (6.3 vs. 6.1 vs. 4.4 & times; 10(3) cells/mm(3), p = 0.0006). Patients with indeterminate TCIP were more likely to have ALC <= 400 cells/& micro;L (32.0% vs. 33.3% vs. 89.3%, p < 0.0001). Incidence of post-prophylaxis CMV infection was comparable. Conclusion In this study, implementing protocolized TCIP testing at 3 months posttransplant in R+ kidney transplant recipients was feasible, with the main limitation being lab related draw-time considerations. Based on our center specific experience, stratification based on patient-specific factors should be considered before widespread implementation to optimize evaluable results given cost burden associated with testing.
Background Pediatric data on preservation fluid cultures (PFCs) and their ability to predict preservation fluid-related posttransplant infections (PF-I) remain uncertain. In addition, clinical guidelines do not provide uniform recommendations regarding when to obtain PFC or how to manage positive results, particularly for children. In this study, we aimed to evaluate PFC-positive status and PF-I in pediatric abdominal solid organ transplant (aSOT) recipients.Methods We conducted a retrospective, single pediatric center study of aSOT-recipients between 2012 and 2024, where PFCs were obtained routinely. Data were collected via chart review and included prespecified outcomes such as posttransplant bacterial infections, allograft rejection, unexpected return to the operating room, prolonged hospitalization, and death within 30 days posttransplant. PF-I was defined as a culture-concordant infection in the setting of PFC-positive status.Results Among 337 aSOT recipients, PFCs were positive in 49 patients (14.5%). Coagulase-negative Staphylococci and Cutibacterium spp. were the most isolated organisms (63%). Infectious complications were more frequent in patients with PFC-positive status (30.6% vs. 18.4%; p = 0.049). Two PF-I episodes (4.1% of PFC-positive status) were identified, both in infant liver transplant recipients, involving vancomycin-resistant Enterococcous and methicillin-sensitive Staphylococcus aureus. At 30 days after transplantation, a higher percentage of the PFC-positive group remained hospitalized (18.4% vs. 8.7%; p = 0.037), whereas of the proportion of rejection, reoperation, and mortality was similar.Conclusions PFC-positive status and PF-I were uncommon in this cohort. The utility of routine bacterial PFC is primarily to identify the growth of organisms considered pathogenic and to guide preemptive antibiotic therapy.
