Indian Society of Organ Transplantation Consensus Recommendations on Latent Tuberculosis in Kidney Transplantation
Manish Balwani, Pranjal Kashiv, Sourabh Sharma, Vivek Kute, Sanjay Kolte, Anil Kumar, Atul Humar, Deepali Kumar, Jigar Shrimali, Lalit Pursnani, Abi Abraham M., Feroz Aziz, Jai Prakash Tiwari, Arpita Ray Chaudhury, Gireesh M S, Rajashekhar, Mahesh Eswarappa, Shankar Prasad Nagaraju, Dhananjai Agarwal, Vikas Jain, Debasis Das, S. K. Agarwal, Vrushali Deshpande, Subho Banerjee, Pratik Das, Divyesh Engineer, Umapati Hegde, Amol Bhawane, Sree Bhushan Raju, Shruti Tapiawala, Hari Shankar Meshram, Narayan Prasad, Georgi Abraham, Kapil Sejpal, Priyanka Tolani, Nitin Shinde, Mohan Patel, Amit PasariABSTRACT
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.