Transmission of <i>Mycobacterium tuberculosis</i> with Renal Allografts

Abstract

Disseminated tuberculosis occurred in 2 allograft recipients of kidneys procured on the same donor. Both recipients were treated by low dose prednisolone and azathioprine, and one of them was on a special protocol including antilymphocyte globulins as rejection prophylaxis. None of them experienced acute rejection. The early posttransplant period was uneventful except for the occurrence of mild viral infections in both cases (herpes simplex virus in case 1 and cytomegalovirus in case 2). 2 and 6 months after transplantation, respectively, patient 1 developed acute fever, asthenia, and disorientation while patient 2 presented with spiking fever and miliary pneumonitis. Mycobacterium tuberculosis grew in the urine of both recipients in the absence of clinical genitourinary symptoms. The two mycobacterial species had the same bacteriologic characteristics and the same antibiotic sensitivity. As the recipients had no evidence of a previous history of active tuberculosis, it is suggested, as for some other infectious agents, that mycobacterium was transmitted along with the transplanted kidneys.

Genitourinary Tuberculosis after Renal Transplantation: Report of 3 Cases and Review

“…Predisposing conditions, such as malnutrition, diabetes mellitus, and chronic corticosteroid therapy, play a role in the development of disease. In contrast, genitourinary tuberculosis was recognized within 6 months after surgery in 5 of the 11 renal transplant patients whose cases we review or report in the present study [2,3,6,7]. In 2 of these patients, infection appeared to have been acquired from the donor kidney [6].…”

“…Seven patients were male and 4 were female. Of the 8 previously described patients, 1 was born in the United States [2], and 1 was from India [6]. Ethnic or national origin was not reported for the other 6 patients.…”

“…Findings of chest radiography were abnormal for 6 (55%) of 11 patients, although they were not suggestive of tuberculosis. Results were normal for 2 of 4 transplant patients who underwent iv pyelography (IVP) [3,6]. Abnormal IVP results showed an obstructed transplanted kidney with ureteral stenosis, chronic infection, or infarction of the upper pole [1,5].…”

Genitourinary Tuberculosis after Renal Transplantation

“…İmmün sistemi normal kişilerde genitoüriner sistem tüberkülozu primer infeksiyonu takiben 8-39yıl arasında ortaya çıkmaktadır (7). Renal transplantasyon sonrası ise genitoüriner TB ortaya çıkış zamanı en erken altı ay en geç beş yıl olarak bildirilmektedir (8)(9)(10). Vakamız, transplantasyon sonrası ikinci ayda tanı alması itibariyle de literatürde erken sayılabilecek vakalardandır.…”

Profilaxis de tuberculosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos

“…Toda enfermedad por M. tuberculosis en el donante o receptor debe ser tratada hasta su regresión microbiológica y resolución radiológica antes de considerar el trasplante 17 . Un donante con TBC activa o sospecha de ella no debe ser considerado para trasplante 1,18 .…”