Mycobacterium tuberculosisInfection following Kidney Transplantation

Abstract

Introduction and Aims. Post-transplant tuberculosis (TB) is a problem in successful long-term outcome of renal transplantation recipients. Our objective was to describe the pattern and risk factors of TB infection and the prognosis in our transplant recipients. Patients and Methods. This study was a retrospective review of the records of 491 renal transplant recipients in our hospital during the period from January 1986 to December 2009. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. Results. 16 patients (3,2%) developed post-transplant TB with a mean age of 32,5 ± 12,7 (range: 13–60) years and a mean post-transplant period of 36,6months (range: 12,3 months–15,9 years). The forms of the diseases were pulmonary in 10/16 (62,6%), disseminated in 3/16 (18,7%), and extrapulmonary in 3/16 (18,7%). Graft dysfunction was observed in 7 cases (43,7%) with tissue-proof acute rejection in 3 cases and loss of the graft in 4 cases. Hepatotoxicity developed in 3 patients (18,7%) during treatment. Recurrences were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Conclusion. Extra pulmonary and disseminated tuberculosis were observed in third of our patients. More than 9months of treatment may be necessary to prevent recurrence.

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

“…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.…”

“…The reported prevalence of TB in renal transplantation recipients ranges from 0.5% to 15%. 3,7 Differences in these values may be attributed largely to epidemiological factors in developed and developing regions. TB also presents particular challenges because of delayed diagnosis and side effects of therapy.…”

“…Common clinical abnormalities include pyrexia, pulmonary infiltrates, exudative pleural effusion and exudative ascites. 3,7,8 The resurgence of TB since the 1980s due to the acquired immunodeficiency syndrome epidemic and increasing numbers of other immunocompromised individuals, including organ transplantation recipients, makes this disease a topic of universal concern.…”

“…15,19,24 The mortality rate observed in this study falls within the previously reported range of 12.5-32% among kidney transplantation recipients with post-transplantation TB. 3,19 Mortality is higher when TB develops in the first year after kidney transplantation among poorly nourished patients and hypoxic patients treated with steroids. 3 In our sample, most deaths occurred in the group of patients with miliary nodules, which showed a significant increase in mortality.…”

“…2 Immunosuppression in transplantation recipients accounts for progressive impairment in cellular immune function, allowing infection by Mycobacterium tuberculosis, an intracellular pathogen. 3 With the emergence of new and potent immunosuppressive regimens, the incidence of TB among transplantation recipients may increase. Most transplantation patients with TB manifest clinical pulmonary infection.…”