Tuberculosis after kidney transplantation is associated with significantly impaired allograft function

Costa, Silvana Daher; Sandes‐Freitas, Tainá Veras de; Jacinto, Camilla N.; Martiniano, Lorena Vasconcelos Mesquita; Amaral, Yago Sucupira; Paes, Fernando José Villar Nogueira; Sales, Maria Luiza de Mattos Brito Oliveira; Esmeraldo, Ronaldo de Matos; Daher, Elizabeth De Francesco

doi:10.1111/tid.12750

Cited by 19 publications

(25 citation statements)

References 16 publications

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“…[11,22] Owing to the difficulties in diagnosis and treatment, the mortality of active tuberculosis in renal transplant recipients is still 6% to 10% [4,15] with about 15% graft loss and a median GFR decrease of 10 mL/min during therapy. [23] In our case, the kidney transplant function even improved with therapy. This can partially be attributed to the reduction in cyclosporine doses but might also be because of renal involvement of tuberculosis, [24] which is supported by the sterile pyuria.…”

Section: Discussionmentioning

confidence: 58%

Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient

Schmidt-Lauber¹,

Jacobi²,

Polifka

et al. 2019

Medicine

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Rationale:Active tuberculosis constitutes a relevant risk for kidney transplant recipients. In contrast to immunocompetent hosts, kidney transplant recipients often show atypical presentation and course of the disease impeding diagnosis. Especially extrapulmonary or disseminated infection is more frequent and can resemble malignant processes. However, reactivation of tuberculosis mostly develops within the early post-transplant course, whereas malignancies are predominantly long-term complications. We report a case of disseminated abdominal tuberculosis developing 10 years after kidney transplantation and review the underlying literature.Patient concerns and diagnoses:A 51-year-old lady presented with epigastric pain, diarrhea, weight loss and night sweats 10 years after deceased-donor kidney transplantation. An epigastric as well as multiple peritoneal masses were found suspicious of a cancer of unknown primary. Colonoscopy revealed a colon tumor with the biopsy showing no dysplasia but histiocytic and granulomatous infiltration with acid-fast bacilli. Mycobacterium tuberculosis was detected in the biopsy and stool and disseminated abdominal tuberculosi was diagnosed.Interventions and outcomes:With anti-tuberculosis therapy, the masses regressed, and all cultures became sterile, sparing graft function.Lessons:This case emphasizes how variable and unspecific the presentation of tuberculosis in kidney transplant recipients may be and that tuberculosis constitutes a relevant risk also in the long-term post-transplant course.

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Section: Discussionmentioning

confidence: 58%

Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient

Schmidt-Lauber¹,

Jacobi²,

Polifka

et al. 2019

Medicine

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“…Our study has certain strengths: (1) we included nationwide KT events in the recent period, (2) the study was performed in a nation with moderate TB prevalence, (3) we included a relatively large number of active TB cases, and (4) a comparison between the KT group and the matched dialysis or general population group was performed. [5][6][7]26 In the study, KT patients showed a significantly higher risk of active TB than the age-sex-matched general population group, even after adjusting the comorbidities. This is in accordance with the current guidelines suggesting additional screening for TB to be performed for potential KT recipients.…”

Section: Discussionmentioning

confidence: 75%

Risk of active tuberculosis infection in kidney transplantation recipients: A matched comparative nationwide cohort study

Park

Kim

et al. 2021

American Journal of Transplantation

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Kidney transplantation (KT) is the foremost kidney replacement therapy for patients with end-stage kidney disease (ESKD). 1 There is firm evidence that KT benefits the prognosis and quality of life of ESKD patients, and the prognosis of KT has improved over time. 2 However, unresolved posttransplant complications are still observed, including metabolic disorders, malignant diseases, infectious diseases, or rejection, which are threatening to the survival of the allografts and recipients.As KT requires long-term immunosuppression, an increase in the infectious risk or reactivation of Mycobacterium tuberculosis (TB), one of the Top 10 causes of global deaths, 3 is seen after KT. 4 TB after KT is associated with greater risks of allograft failure and posttransplant deaths, 5-8 which has been reported mainly in Western countries. Thus, active TB after KT is considered an important infectious complication in KT recipients. Current guidelines recommend routine screening for TB in potential recipients, and complete treatment or prophylactic measures are necessary according to the

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“…Costa et al showed that post-transplant tuberculosis in kidney transplant recipients was associated with a high incidence of acute kidney injury without recovery of baseline renal function after treatment. 5 Similarly, our patient was hospitalized due to an increase in creatinine and diagnosed with tuberculosis. The patient's creatinine level remained higher than baseline in the 3rd month of tuberculosis treatment.…”

Section: A Case Of Tuberculosis Mimicking Lung Cancer In a Kidney Transplant Recipientmentioning

confidence: 75%

A case of tuberculosis mimicking lung cancer in a kidney transplant recipient

Ataş

Kantarcı

2021

Transplant Infectious Dis

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Tuberculosis after kidney transplantation is associated with significantly impaired allograft function

Abstract: Post-transplantation TB was associated with a high incidence of AKI, and complete recovery of baseline renal function was not achieved after treatment. The severity of TB disease, AKI, and AR episodes that occurred after TB diagnosis are potential causes for this outcome.

Cited by 19 publications

References 16 publications

Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient

Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient

Risk of active tuberculosis infection in kidney transplantation recipients: A matched comparative nationwide cohort study

A case of tuberculosis mimicking lung cancer in a kidney transplant recipient

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