Indian Society of Organ Transplantation Consensus Recommendations on Latent Tuberculosis in Kidney Transplantation

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.