Tuberculosis in transplant recipients: diagnostic and therapeutic dilemmas

Subramanian, Aravind Kumar; Nuermberger, Eric L.

doi:10.1111/j.1399-3062.2008.00332.x

Cited by 13 publications

(14 citation statements)

References 13 publications

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“…There are data showing that treatment of short duration (<9 months) is associated with greater mortality among transplant recipients . 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 .…”

Section: Discussionmentioning

confidence: 99%

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

Marques

Azevedo

Pierrotti

et al. 2013

Clinical Transplantation

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Section: Discussionmentioning

confidence: 99%

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

Marques

Azevedo

Pierrotti

et al. 2013

Clinical Transplantation

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“…However, in patients with chronic renal failure tuberculin test shows high rates of anergy due possibly to impaired cellular immunity because of uremia, and hence has a low sensitivity and specificity in detecting latent TB infection. 2,10,11 In the study conducted by Kantarci et al, prevalence of tuberculin positivity and anergy in asymptomatic chronic renal failure patients waiting for transplantation were 42.1% and 43.3%, respectively. And 14.5% of positives had a previous TB history.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in Renal Transplant Recipients

et al. 2011

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Background: Renal transplant recipients should be considered at high risk for development of Mycobacterium tuberculosis infection (tuberculosis, TB). TB is relatively more frequent among transplant recipients than general population, depending on its epidemicity in the geographic region. Clinical manifestations in this group of patients may be atypical and deserve aggressive investigations for diagnosis. Tuberculin skin test has several limitations regarding diagnosis in chronic renal failure patients. In this retrospective study, we aimed to explore the prevalence and clinical manifestations of TB in renal transplant patients. Materials and methods: We retrospectively analyzed the data for TB prevalence, clinical presentations, and patient and graft survivals of total 320 pediatric and adult renal transplant recipients in our center between 1992 and 2010. Results: The prevalence of TB was 2.8%. Five patients received kidney from living-donor related and four from cadaveric donors. Cadaveric-donor patients received antithymocyte globulin for induction, and four patients received pulse steroid for acute rejection. The median duration of time between transplantation and TB was 21 (1-150) months, and between induction/pulse therapy and infection was 5 (1-100) months. The immunosuppressive protocols included prednisolone and cyclosporine/rapamycin with or without mycophenolate mofetil/azathioprine. The major symptoms were fever (77%), cough (66%), and abdominal pain (22%). Extrapulmonary TB with intestinal (2/9), pericardial (1/9), lymph node (1/9), and cerebral (1/9) involvements developed in five patients. One patient had both pulmonary and testicular involvements. All patients received quartet of anti-TB therapy for a median duration of 9 months. One patient died at the second month of therapy because of dissemination of TB, and one patient returned to hemodialysis because of chronic allograft nephropathy. Conclusion: The prevalence of TB was 2.8% in our renal transplant patients. The quartet of anti-TB treatment including rifampicin resulted in success in a majority of patients.

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“…e extrapulmonary and disseminated forms and nonspeci�c symptoms are more frequent than those of the general population and we veri�ed this trend. us, the traditional diagnostic methods such as X-ray, demonstration of acid-alcohol resistant bacilli in body �uids smears, and growth of TB bacilli in culture specimens are unable to identify the subjects which also appear in our sample [5,11,13].…”

Section: Discussionmentioning

confidence: 89%

“…Some drugs for TB treatment are nephrotoxic and can lead to a negative outcome either for transplantation or for TB treatment [13][14][15]. High fever and erythema occurred upon resumption of isoniazid; however, the symptoms gradually improved with oral prednisolone aer cessation of isoniazid and transplant recipients generally took this corticoid routinely for gra support [5].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis Characterization in a Special Population of Kidney Transplant Recipients

Reis-Santos

Maciel

2013

ISRN Infectious Diseases

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Setting. Tuberculosis clinical presentation is not typical in kidney transplant recipients and the diagnosis of active disease is usually delayed. Objective. To characterize tuberculosis presentation in Brazilian's kidney transplant recipients. Study Design. We analyzed the clinical records of tuberculosis cases regarding sociodemographic data and health history. Results. irteen TB cases were identi�ed among 843 transplant recipients. e average time for TB development aer transplantation was 4 years. Eight subjects presented pulmonary disease, seven patients required hospitalization Alertness to the possibility of TB and the careful evaluation for possible TB of all kidney transplant recipients with unexplained is vital, as is the related work of transplant and TB control teams and four died as a consequence of TB. Conclusion. e severe consequences of TB in posttransplantation can become critical.

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Tuberculosis in transplant recipients: diagnostic and therapeutic dilemmas

Cited by 13 publications

References 13 publications

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

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

Tuberculosis in Renal Transplant Recipients

Tuberculosis Characterization in a Special Population of Kidney Transplant Recipients

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