Tuberculosis in renal transplant recipients on various immunosuppressive regimens

Atasever, Alev; Bacakoğlu, Feza; Töz, Hüseyin; Başoğlu, Özen K.; Duman, Soner; Basak, Kemal; Güzelant, Asuman; Sayıner, Abdullah

doi:10.1093/ndt/gfh691

Cited by 72 publications

(57 citation statements)

References 16 publications

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“…The high incidence of TB in kidney transplant recipients is associated with the use of immunosuppressants, such patients already being immunocompromised by chronic renal failure and uremia. (24,25) Among immunocompromised patients, the most common radiological pattern is primary TB, with adenopathy, consolidation, and pleural effusion. (26) In case studies of different types of transplantation, TB is described in its disseminated, extrapulmonary, or miliary form in approximately 45% of cases.…”

Section: Discussionmentioning

confidence: 99%

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

et al. 2010

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Objective: To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. Methods: This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated. Results: During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids. Conclusions: The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients. Keywords: Hospitalization; Immunosuppression; Risk factors; Tuberculosis/mortality; Immunocompromised host. ResumoObjetivo: Investigar as características de pacientes imunocomprometidos não HIV com diagnóstico intrahospitalar de tuberculose e determinar os fatores de risco para mortalidade. Métodos: Durante um período de dois anos, foi realizado um estudo de coorte retrospectivo que incluiu os pacientes com diagnóstico de tuberculose após a internação. Os fatores preditores de mortalidade foram coletados. Resultados: Durante o período do estudo, 337 pacientes foram internados e diagnosticados com TB, e desses, 61 apresentavam imunossupressão não decorrente da infecção pelo HIV. A tuberculose extrapulmonar estava presente em 47,5% dos casos. Nesse grupo, a taxa de mortalidade intra-hospitalar foi de 21,3%, e a mortalidade após a alta foi de 18,8%. Os pacientes imunocompetentes tiveram sobrevida em um ano maior que os pacientes com HIV (p = 0,008) e que os imunocomprometidos não HIV (p = 0,015), mas não houve diferença na sobrevida entre esses dois últimos grupos (p = 0,848). Entre os pacientes imunocomprometidos não HIV, o único fator estatis...

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Section: Discussionmentioning

confidence: 99%

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

et al. 2010

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“…The TB skin tests and culture are often negative in the transplant population. 14,15 As shown in our patient, traditional tests such as Ziehl-Neelsen staining and culture of sputum specimens for revealing Mycobacterium tuberculosis were negative. Therefore, multiple tissue specimens obtained from lymph nodes, bone marrow specimens, liver, kidney, and pleural and peritoneal samples, according to the clinical context, may be necessary.…”

Section: Discussionmentioning

confidence: 61%

“…17 Interferon-gamma detection is a diagnostic test developed recently to improve sensitivity, which allows a rapid TB diagnosis, particularly in patients with culture-negative TB. 14 However, it should not be used initially for diagnosis of active TB.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Barbouch

Hajji²,

Helal³

et al. 2017

Exp Clin Transplant

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Tuberculosis is one of the leading infections after renal transplant, particularly in developing countries where the incidence and prevalence in the general population are high. Diagnosis requires bacteriologic and histologic confirmation. Interactions among the antitubercular drugs and the immunosuppressive agents have to be considered while prescribing, and surveillance for adverse effects is required. Although rare, case reports are available on extrapulmonary tuberculosis in allograft recipients. Here, we present a 25-year-old kidney transplant recipient who was diagnosed with lymph node tuberculosis under uncommon circumstances but who had a good outcome. This case report illustrates the difficulties in diagnosis of tuberculosis, changes in therapeutic protocols, and prognostic factors and highlights the effects of infectious complications with immunosuppressive therapy in this particular patient population.

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“…12,13 In a study by Atasever et al, 14 it was reported that immunosuppressive regime including TAC and MMF was associated with the development of TB earlier in the post-transplantation period. Considering that our patient did not have other confounding risk factors such as diabetes, chronic liver disease, low socioeconomic status, and other coexisting opportunistic infection, this may be the major risk factor for predisposition to TB in our case.…”

Section: Discussionmentioning

confidence: 98%

Differential Diagnosis of an Unusual Pelvic Mass in a Renal Transplant Recipient: Multidrug-Resistant Abdominopelvic Tuberculosis

et al. 2011

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Renal transplant patients are more prone to tuberculosis infection due to the underlying intense immunosuppression, with an incidence 20-74 times higher than that in the general population. It is associated with graft dysfunction and increased mortality rates. It can be frequently pulmonary but extra-pulmonary involvement is not rare, and in the latter case, it may be misinterpreted as genital malignancies. In this case report, we discuss a renal transplant patient with pelvic pain and fever, who was later diagnosed as having abdominopelvic tuberculosis.

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Tuberculosis in renal transplant recipients on various immunosuppressive regimens

Abstract: Immunosuppression with TAC or MMF is associated with the development of TB earlier in the post-tx period and in younger patients.

Cited by 72 publications

References 16 publications

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Untitled

Differential Diagnosis of an Unusual Pelvic Mass in a Renal Transplant Recipient: Multidrug-Resistant Abdominopelvic Tuberculosis

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