Latent Mycobacterium tuberculosis Infection in Liver Transplant Recipients-Controversies in Current Diagnosis and Management

Liver transplantation for end-stage liver disease is increasingly being undertaken in India. 1 Routine tuberculin skin testing (TST) for latent Mycobacterium tuberculosis infection (LTBI) and isoniazid prophylaxis in TST-positive livertransplant recipients (LTRs) is recommended(2,)3 but seldom implemented worldwide.(4-7) The role of TST-testing and isoniazid prophylaxis in LTRs remains further undefined in high prevalence areas, including India. We describe the burden of LTBI in LTRs; the epidemiological aspects of M. tuberculosis infection in high prevalence areas; identifiable risk factors for M. tuberculosis infection; the limitations of current diagnostic techniques for LTBI in LTRs and the efficacy and toxicity of isoniazid prophylaxis in TST-positive LTRs and suggest directions for future investigations in this area.