Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries?
Bamford, Alasdair Dixon, Garth Klein, Nigel Marks, Stephen D Ritz, Nicole Welch, Steven B Tebruegge, Marc
Bamford, Alasdair
Dixon, Garth
Klein, Nigel
Marks, Stephen D
Ritz, Nicole
Welch, Steven B
Tebruegge, Marc
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Affiliation
Great Ormond Street Hospital for Children NHS Foundation Trust; University College London Great Ormond Street Institute of Child Health; University of Basel Children's Hospital; Royal Children's Hospital Melbourne; University Hospitals Birmingham NHS Foundation Trust; Guy's and St. Thomas' NHS Foundation Trust
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Publication date
2020-11-27
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Abstract
The risk of tuberculosis (TB) disease is increased in children with chronic kidney disease (CKD), even higher in stage 5 CKD/kidney failure and especially high after kidney transplantation due to immunosuppression. TB disease may follow recent primary infection, or result from reactivation of latent infection. Reactivation is more common in adults, while progression following primary infection makes up a greater proportion of disease in children. Recommendations for preventing TB disease in some low TB incidence countries have previously included offering Bacillus Calmette-Guérin (BCG) vaccine to all children listed for kidney transplant if they had not received this as part of previous national immunisation programmes. Based on the available evidence, we recommend modifying this practice, focusing instead on awareness of risk factors for TB exposure, infection and disease and the use of appropriate testing strategies to identify and treat TB infection and disease.
Citation
Bamford A, Dixon G, Klein N, Marks SD, Ritz N, Welch SB, Tebruegge M. Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries? Pediatr Nephrol. 2021 Oct;36(10):3023-3031. doi: 10.1007/s00467-020-04844-5. Epub 2020 Nov 27. Erratum in: Pediatr Nephrol. 2021 Oct;36(10):3283. doi: 10.1007/s00467-020-04893-w.
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Article