Tuberculosis in renal transplant patients

Abstract

Tuberculosis (TB) was diagnosed in 25 of 466 patients who underwent renal transplant over a period of 15 years. TB developed from 1 month to 9 years post-transplant. In 56% of the cases the onset was within the first post-transplant year. TB affected several isolated or combined organs. Pulmonary involvement was present in 76% of cases, either as isolated pleuro-pulmonary (56%) or associated with other sites (20%). The non-pulmonary sites were: skin, joints, tests, urinary tract, central nervous system and lymphonodules. The diagnosis was confirmed by biopsy in 64% of the cases, by identification of tubercle bacilli in 24% and only at necropsy in 12% Biopsy specimens could be classified in three histological forms: exudative, that occurred in early onset and more severe cases granulomatous in late onset and benign cases; and mixed in intermediate cases. Azathioprine dosages were similar along post-transplant time periods in TB patients and in the control groups; and in TB patients who were cured and who died. The number of steroid treated rejection crises was greater in TB than in the control group. Prednisone doses were higher and the number of rejection crises was greater in TB patients who died than in those who were cured. Fifteen patients were cured and ten died, two of them of causes unrelated to TB. Six of the eight TB-related deaths occurred in the first 6 post-transplant months. The outcome was poor in patients in whom TB arose early in post-transplant period and where the exudative or mixed forms were present; whereas the prognosis was good in patients with late onset and granulomatous form of TB. In one patient TB was transmitted by the allograft.

Clinical features and outcomes of tuberculosis in kidney transplant recipients in Brazil: a report of the last decade

“…In this study, 2.8% of the kidney transplant recipients developed post‐transplant tuberculosis, an incidence density of 803 cases/100 000 patient‐years, which is approximately 20 times higher than that reported for the general population of Brazil (43 cases per 100 000 inhabitants per year; relative risk of 18.7), an intermediate‐to‐high burden TB country . The RESITRA (Spanish Network of Infection in Transplantation) cohort previously reported similar data, with an incidence of 358 cases/100 000 patient‐years, the relative risk being 18.9 when compared with that estimated for the general population of Spain .…”

“…The current tuberculosis crude and related mortality remains very high, and it is also associated with a high morbidity rate, because antituberculosis therapy may produce alterations in the metabolism of immunosuppressive drugs . In some studies, despite close monitoring of immunosuppressive trough levels, hepatic function, and renal function, patients have developed acute rejection leading to graft loss . Death in conjunction with tuberculosis is more frequent among patients associated with graft rejection, receipt of steroid or lymphocyte–depleting antibodies therapy, and presence of other opportunistic infection concomitant with tuberculosis .…”

Mycobacterium Tuberculosis Infection Following Kidney Transplantation

“…Then, chronic renal failure patients who are awaiting transplantation should be carefully evaluated for previous TB anamnesis and family history. Rarely, in less than five percent of patients, TB is caused by nosocomial acquisition or donor transmission [12,13].…”

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“…15 Blood levels of calcineurin inhibitors should be monitored closely with an increase in doses. 21,22 Antilymphocyte globulin can be used as antirejection prophylaxis. 15 Chronic allograft nephropathy has been reported in 65% of patients, which has a negative impact on graft survival.…”