Renal allograft tuberculosis with infected lymphocele transmitted from the donor

Abstract

Transmission of tuberculosis (TB) from a donor through renal transplantation is a rare incident. We are reporting a 53-year-old Qatari woman diagnosed with renal allograft TB infection. The disease was confirmed by isolation of Mycobacterium tuberculosis from fluid from the lymphocele and demonstration of caseating granuloma in graft biopsy with acid-fast bacilli seen on Ziehl-Neelsen staining. The diagnosis was made quite early post-transplantation. The presence of the granuloma, which is unusual with patients on intensive immunosuppressant medications, suggests that transmission of the infection occurred from the donor rather than from the activation of latent infection. In reviewing the literature, we found ten case reports of TB in transplanted kidney with transmission of TB infection from the donor. The presence of TB in lymphocele in association with the infected transplant by TB, to the best of our knowledge, was reported only once in the literature. Our case had unfavorable outcome and ended by renal allograft nephrectomy and hemodialysis. We are presenting this case of TB infection of renal allograft and lymphocele diagnosed early post-transplantation transmitted from the donor and pertinent review from the literature.

Mycobacterium tuberculosisafter solid organ transplantation: A review of more than 2000 cases

“…Twenty‐three cases of donor‐derived TB (DDTB) were identified (Table ) . Thirteen (56.52%) were proven by molecular analysis.…”

“…During the period from 1998 to 2016, a total of 187 studies reported 2082 cases of TB after SOT . The majority (135/187 [72.19%]) were case reports or series, while the remainder were retrospective studies (n = 43),…”

“…Reactivation of latent TB was the most common mode of acquisition. Among patients with TB, information regarding TB risk factors including prior TB exposure, either through clinical history, tuberculin skin testing, or imaging, was reported in only 140 of 364 cohort patients and detailed in 81 of 165 case reports . Only 36 of 140 (25.71%) cohort patients were given INH prophylaxis.…”

Donor derived Mycobacterium tuberculosis infection after solid‐organ transplantation: A comprehensive review

“…Through December 2016, a total of 22 case reports, 2 case series and 1 cohort reported on 36 cases of proven (n = 17), probable (n = 8), and possible (n = 11) DDTB cases among 16 lung, 13 kidney, 6 liver, and 1 heart recipient.…”

“…Overall, the median duration of treatment was 10.5 (range, 6-24) months (Table 3). Among those who completed treatment, the length of therapy for liver, kidney, and lung recipients was a median of 9 (range, 6-18), 12 (range, [9][10][11][12][13][14][15][16][17][18], and 18 months (range, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] respectively. All-cause mortality was 9/36 (25%), with TB-attributable mortality of 44% (4/9).…”