Tuberculosis in renal transplant recipients

Abstract

Tuberculosis (TB) has been described in kidney transplant recipients as an infection with predominantly pulmonary involvement. We report the impact of TB in kidney transplantation. Clinical records of adult kidney recipients, transplanted between 1 January 1986 and 31 December 1995 were analyzed for sex, age, graft origin, immunosuppressive therapy, TB sites, diagnostic methods and concomitant infections. Annual incidence, mean time of onset, relation to rejection treatment, tuberculin skin test (PPD) and outcome were analyzed. Patients with a history of TB or graft loss in the first month were excluded. TB was diagnosed in 14 of 384 (3.64%). Mean age at transplantation was 35 years. Twelve of these received the graft from a living donor. All had triple immunosuppression with cyclosporine. Ten had pulmonary TB, three extrapulmonary infection and one disseminated disease. In 13 cases an invasive diagnostic procedure was performed. Mycobacterium tuberculosis cultures were positive in all cases; microscopy revealed acid-fast bacilli (AFB) in 6, and adenosine deaminase was elevated in CSF and pleural effusion in 2. Annual incidence varied from 0% to 3.1%. At the time of TB presentation 8 patients had other concomitant infections (cytomegalovirus, nocardia, Pneumocystis carinii, disseminated herpes simplex virus). Median time of onset was 13 months. Diagnostic results became available post-mortem in 2 cases, and one had TB in a failing allograft. TB was treated with 4 drugs including rifampin in 10 patients. Cyclosporine was discontinued in one, lowered in one and increased in 8. During treatment 5 patients had rejection episodes. At 1 year, graft survival was 72.7% and patient survival 90.9%. TB was more prevalent when recipient and donor were both PPD positive. In summary: although TB is a growing threat in the transplant setting, early and aggressive diagnosis with meticulous monitoring of immunosuppression allows a successful outcome for both patient and graft. Optimal prophylaxis guidelines have yet to be completely defined.

Mycobacterium Tuberculosis Infection Incidence in Hospitalized Renal Transplant Patients in the United States, 1998–2000

“…The variation in morbidity of anti-tuberculosis therapy depends in part on the immunosuppressive regimens. Patients on cyclosporine A (CsA) (23,(25)(26)(27) and tacrolimus (28,29) seem to be at higher risk of graft loss when these medications are combined with an antituberculosis drug such as rifampin. This is in part due to the cytochrome P450 induction of the metabolism of CsA by rifampin and the need for increased dosing of CsA.…”

Mycobacterium tuberculosis Infection in Recipients of Solid Organ Transplants

“…For any given country, the incidence of tuberculosis among transplant recipients seems to be directly associated with the specific incidence in the general population, but the former is usually 20-74 times higher than the latter [1][2][3]5].…”

“…Transmission of tuberculosis from a living donor has been reported in cases of liver [15] and kidney transplantation [5]. Active tuberculosis should be excluded for potential living donors by means of all available diagnostic techniques, including PCR.…”

Mycobacterium Tuberculosis in Solid Organ Transplantation: Incidence before and after Expanded Isoniazid Prophylaxis

“…1 In developing countries, the limited data indicate rates up to 100 times that of the general population. 2 The proporMycobacterium tuberculosis in solid organ transplantation: incidence before and after expanded isoniazid prophylaxis 20 recipients (1.02%) developed tuberculosis. Twelve cases (60%) developed tuberculosis within one year of transplantation.…”