Tuberculosis in renal transplant recipients

Arslan, Hande; Ergin, Funda; Oner-Eyuboglu, F; Akçay, Şule; Karakayalı, H.; Haberal, Mehmet

doi:10.1016/j.transproceed.2003.09.091

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…3,[14][15][16] Other radiographic findings in these patients include infiltrates (27.6-37.5%), cavities (6.2-20.7%), nodules (12.5%), lymph node enlargement (12.5%) and pleural effusion (31.2-41.4%). 3,8,[14][15][16][17][18][19][20] However, most previous studies describing imaging findings in these patients have used conventional radiography. The sensitivity and specificity of chest radiography are limited in patients with diffuse lung disease, and chest radiography findings are normal in up to approximately 10% of immunocompromised patients with acute lung disease.…”

Section: Discussionmentioning

confidence: 95%

High-resolution CT findings of pulmonaryMycobacterium tuberculosisinfection in renal transplant recipients

Pereira

Gazzoni

Marchiori

et al. 2016

BJR

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Objective: Renal transplantation recipients are at increased risk of Mycobacterium tuberculosis infection because of immunosuppression. The aim of this study was to assess high-resolution CT (HRCT) findings in renal transplantation recipients diagnosed with pulmonary tuberculosis (TB). Methods: We reviewed HRCT findings from patients diagnosed with pulmonary TB, established by M. tuberculosis detection in bronchoalveolar lavage, sputum or biopsy sample. Two observers independently reviewed HRCT images and reached consensus decisions on the presence and distribution of: (i) miliary nodules, (ii) cavitation and centrilobular tree-in-bud nodules, (iii) ground-glass attenuation and consolidation, (iv) mediastinal lymph node enlargement and (v) pleural effusion. Results: The sample comprised 40 patients [26 males, 14 females; median age, 45 years (range, 12-69 years)]. The main HRCT pattern was miliary nodules (40%), followed by cavitation and centrilobular tree-in-bud nodules (22.5%), ground-glass attenuation and consolidation (15%), mediastinal lymph node enlargement (12.5%) and pleural effusion (10%). The distribution of findings in patients with miliary nodules was random. In patients with cavitation and centrilobular tree-in-bud nodules, 66.6% of abnormalities were found in the upper lobes. Pleural effusion was unilateral in 75% of cases. The overall mortality rate was 27.5%. This rate was 50% in patients with miliary nodules, and 72.6% of all deaths occurred in this group. Thus, mortality was increased significantly in patients with miliary nodules (p , 0.05). Conclusion:The main HRCT finding in renal transplantation recipients with pulmonary TB was miliary nodules, followed by cavitation and centrilobular tree-in-bud nodules. Miliary nodules were associated with a worse prognosis in these patients. Advances in knowledge: We report the first series on HRCT findings of microbiologically confirmed pulmonary TB exclusively in renal transplantation recipients. The main HRCT finding was miliary nodules, and mortality was increased significantly in these patients.

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Section: Discussionmentioning

confidence: 95%

High-resolution CT findings of pulmonaryMycobacterium tuberculosisinfection in renal transplant recipients

Pereira

Gazzoni

Marchiori

et al. 2016

BJR

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“…14,15 Whereas the prevalence of tuberculosis is 0.5% to 6.4% in low-endemic regions, it is 124 reportedly 15.2% in high-endemic regions. 16,17 Active tuberculosis after transplant may occur in association with various factors, such as latent infection in the recipient, latent infection in the donor, contact with patients with active tuberculosis after transplant, or the need for urgent transplant in a patient with active tuberculosis. The degree of immunosuppression and age are also significant factors that enhance the lifetime cumulative risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Kara

Şen²,

Kurşun³

et al. 2018

Exp Clin Transplant

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Objectives: Pulmonary infections are a significant cause of morbidity and mortality in solid-organ transplant recipients despite enhanced facilities for perioperative care. The aim of this study was to evaluate the demographic characteristics, clinical course, and outcomes of renal transplant recipients with pneumonia. Materials and Methods:The medical records of all renal transplant recipients from January 2010 to December 2014 were retrospectively reviewed, and patients diagnosed with pneumonia according to Centers for Disease Control and Prevention criteria were evaluated. Pneumonia was classified as community acquired or nosocomial. Patient demographics, microbiologic findings, need for intensive care/mechanical ventilation over the course of treatment, and information about clinical follow-up and mortality were all recorded. Results: Eighteen (13.4%) of 134 renal transplant recipients had 25 pneumonia episodes within the study period. More than half (56%) of the pneumonia episodes developed within the first 6 months of transplant, whereas 44% developed after 6 months (all > 1 year). Eight cases (32%) were considered nosocomial pneumonia, and 17 (68%) were considered community-acquired pneumonia. Bacteria were the most common cause of pneumonia (28%), and fungi ranked second (8%). No viral or mycobacterial agents were detected. No patients required prolonged mechanical ventilation. No statistically significant difference was found in the need for intensive care or regarding mortality between patients with nosocomial and community-acquired pneumonia.Two patients (11%) died, and all remaining patients recovered.Conclusions: The present study confirmed that pneumonia after renal transplant is not a rare complication but a significant cause of morbidity. Long-term and close follow-up for pneumonia is necessary after renal transplant. Key words: Complications, Outcome, Renal transplantation IntroductionThe incidence of pulmonary infection after solidorgan transplant (SOT) has decreased with the development of effective prophylactic strategies and improved immunosuppressive treatment regimens. Nevertheless, lower respiratory tract infection remains a life-threatening complication. Approximately two-thirds of pulmonary infiltrations in this group are infectious. 1,2 The incidence of pneumonia in renal transplant recipients reportedly ranges from 8.8% to 20.0%. [3][4][5][6] The mortality rate in this group ranges from 10% to 30% depending on the type of transplant and study duration. 7 Infectious complications vary according to the individual patient's degree of immunosuppression and epidemiologic exposure. Opportunistic infections usually do not occur in the first month after transplant because not all effects of immunosuppression have manifested. Patients waiting for transplant may be colonized with nosocomial microorganisms due to frequent hospital stays, and pulmonary infections in the first month after transplant usually appear as nosocomial pneumonia caused by these microorganisms. Opportunistic pulmon...

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“…32 Most patients with tuberculosis infection present in the first 6 months after transplant, but the onset is later in renal transplant recipients. 12,33 Most transplant recipients with tuberculosis infection have pulmonary tuberculosis (51%), and fever is the most common presenting symptom. 34 Radiographic changes include focal infiltrates, miliary pattern, pleural effusions, diffuse interstitial infiltrates, and cavitary lesions.…”

Section: Infectious Respiratory Complicationsmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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The risk for respiratory complications after solidorgan transplantation continues to be high, even though progress has been achieved with surgical techniques, immunosuppressive agents, and perioperative treatment of transplant recipients. This review is an overview of infectious and noninfectious respiratory complications in liver, kidney, heart, and lung transplant patients. Postoperative respiratory complications are more frequent after liver, heart, and lung transplant recipients, but the incidence is lower in kidney transplant recipients. Lung infiltrates due to multidrug-resistant bacterial infections are increasing and may cause respiratory failure associated with high morbidity and mortality. Treatment strategies including early, broadspectrum empiric antibiotic therapy, lung protective mechanical ventilation, and appropriate timing of tracheotomy for patients who need prolonged mechanical ventilation. Early recognition and aggressive treatment of these respiratory complications may improve outcomes.

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Tuberculosis in renal transplant recipients

Cited by 8 publications

References 5 publications

High-resolution CT findings of pulmonaryMycobacterium tuberculosisinfection in renal transplant recipients

High-resolution CT findings of pulmonaryMycobacterium tuberculosisinfection in renal transplant recipients

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