Mycobacterial infection after renal transplantation in a Western population

Abstract

Mycobacterial infection is a serious opportunistic infection in renal transplant recipients. The incidence is higher in developing than in developed Western countries. This study is a single-centre retrospective review of the records of 2502 renal transplant recipients in Belgium. Fourteen cases of mycobacterial infection (9 Mycobacterium tuberculosis and 5 atypical mycobacterial infection) were diagnosed. The time interval between transplantation and diagnosis was 64 +/- 80 months (mean +/- SD, range 5-188) for M. tuberculosis and 92 +/- 75 months (range 14-209) for atypical mycobacterial infection. The localisation of M. tuberculosis was pulmonary/pleural in 67% and extrapulmonary in 33%. The atypical mycobacterial infections were located in skin, tendons, and joints. Eight patients received IV prednisolone pulse therapy for acute rejection long before the time of mycobacterial infection. The initial antimycobacterial therapy consisted of a combination of isoniazid, rifampicin, and ethambutol in all patients. In patients with M. tuberculosis infection, a good response to antimycobacterial therapy was obtained. In patients with atypical mycobacterial infection, initial treatment was successful in 3 out of 5 patients, in 1 patient recurrence was diagnosed and in another patient, who is still under treatment at present, the initial treatment was adjusted after identification of the atypical mycobacterium and its antibiogram. The incidence of mycobacterial infection after renal transplantation did not increase with newer immunosuppressive therapy. The major risk factor is the total dose of corticosteroids. All patients responded well without major reductions in immunosuppressive therapy. Chemoprophylaxis for high-risk patients still is recommended.

Mycobacterium tuberculosis Infection in Recipients of Solid Organ Transplants

“…Besides, it has not been established whether a specific immunosuppressive drug predisposes to tuberculosis. It has been suggested that suppression of macrophage function by steroid therapy would be more important in triggering mycobacterial infections than IL-2 suppression achieved with more-selective immunosuppressive drugs [45].…”

Incidence and management of mycobacterial infection in solid organ transplant recipients

“…Because renal transplantation has the longest history, the body of literature regarding tuberculosis in renal transplant recipients is larger than that for other types of allografts. In renal transplant recipients, M. tuberculosis was reported in less than 1% of patients in Western countries [5][6][7], 0.8% to 1.6% in Spain [ 8 , 9 ], 2.6% to 3.1% in Turkey [ 10 , 11• ], 1.28% to 5.2% in China [ 12• ] and Taiwan [ 13• , 14• ], and in up to 15% in India [ 15 ]. M. tuberculosis infection after lung transplantation occurs in 0.76% to 6.4% of patients [16][17][18][19].…”

Adverse Reactions of Immunosuppressive Drugs in Iranian Adult Kidney Transplant Recipients

“…The prevalence of posttransplant tuberculosis in the present study (1.67%) was within the range reported from other investigations in Iran (1% to 1.4%) 27,28 and Europe (1% to 4%). 29 Posttransplant diabetes mellitus (PTDM) is a common and serious complication of kidney transplant. 30 According to the results of a systematic review of solid organ transplant recipients, the prevalence of PTDM varies from 2% to 50%.…”