Tuberculosis in renal transplant recipients

Dridi, Amira; Kâaroud, H.; Boubaker, Karima; Abdallah, T. Ben; EI-Younsi, F; Moussa, F. Ben; Hidri, Hafedh; Abderrahim, E.; Khedher, A.; Maı̈z, H. Ben

doi:10.1016/j.transproceed.2003.08.064

Cited by 7 publications

(11 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is the first approved biological agent for chronic use for prophylaxis of acute rejection after KT -a type of treatment regimen that has been associated with an increased risk of TB infection. 15 It is unknown whether the costimulation blockage induced by belatacept is associated with reduced granuloma forma- 16,22,23 In low-burden countries, clinical and radiological suspicion is insufficient to define TB cases, and the decision not to institute empirical therapy is a reasonable option. 15 It is unknown whether the costimulation blockage induced by belatacept is associated with reduced granuloma forma- 16,22,23 In low-burden countries, clinical and radiological suspicion is insufficient to define TB cases, and the decision not to institute empirical therapy is a reasonable option.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of epidemiology, immunosuppressive regimens, clinical presentation, and treatment on kidney transplant outcomes of patients diagnosed with tuberculosis: A retrospective cohort analysis

Viana

Cristelli

Santos

et al. 2019

American Journal of Transplantation

View full text Add to dashboard Cite

Tuberculosis (TB) mortality is high among kidney transplant (KT) recipients. Although local epidemiology is an important factor, diagnostic/therapeutic challenges and immunosuppressive therapy (ISS) may influence outcomes. We analyzed the cumulative incidence (CumI) of TB in KT recipients receiving a variety of ISS with long-term follow-up. Our retrospective single-center cohort study included all KT procedures performed between January 1, 1998, and August 31, 2014, with follow-up until August 31, 2014. Induction therapy was based on perceived immunological risk; maintenance ISS included prednisone and calcineurin inhibitor (CNI) plus azathioprine (AZA), and mycophenolic acid (MPA) or mechanistic target of rapamycin inhibitor (mTORi). Thirty-four patients received belatacept/MPA. KT was performed on 11 453 patients and followed for 1989 (IQR 932 to 3632) days. Among these, 152 patients were diagnosed with TB (CumI 1.32%). Median time from KT to TB was 18.8 (IQR 7.2 to 60) months, with 59% of patients diagnosed after the first year. Unadjusted analysis revealed an increasing confidence interval (CI) of TB (0.94% CNI/AZA vs 1.6% CNI/MPA [HR = 1.62, 95% CI = 1.13 to 2.34, P = .009] vs 2.85% CNI/mTORi [HR = 2.45, 95% CI = 1.49 to 4.32, P < .001] vs 14.7% belatacept/MPA [HR = 13.14, 95% CI = 5.27 to 32.79, P < .001]). Thirty-seven (24%) patients died, and 39 (25.6%) patients experienced graft loss. Cytomegalovirus infection (P = .02) and definitive ISS discontinuation (P < .001) were associated with death. Rejection (P = .018) and ISS discontinuation (P = .005) occurred with graft loss. TB occurred at any time after KT and was influenced by ISS. K E Y W O R D S clinical research/practice, complication: infectious, immunosuppressant -fusion proteins and monoclonal antibodies: belatacept, infection -mycobacterial, infection and infectious agents, infectious disease, kidney transplantation/nephrology

show abstract

Section: Discussionmentioning

confidence: 99%

“…,23 Due to the known high mortality rate associated with TB after KT, all patients with TB had significant dose reductions or discontinuation of the immunosuppressive therapy. This intervention was individualized, precluding systematic analysis.…”

mentioning

confidence: 99%

Influence of epidemiology, immunosuppressive regimens, clinical presentation, and treatment on kidney transplant outcomes of patients diagnosed with tuberculosis: A retrospective cohort analysis

Viana

Cristelli

Santos

et al. 2019

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…40 In most instances, post-transplantation TB manifests as pulmonary infection, but in one-third of these cases the disease is disseminated. Dridi and others 41 reported five cases of TB among 368 (1.3%) kidney transplant receptors over 22 years. Three patients had pulmonary lesions, one with lymphadenopathy.…”

Section: Tuberculosis and Transplantationmentioning

confidence: 97%

“…The main findings were fever, anorexia, weight loss, and palpable lymphadenopathy. 41 Basiri and others 42 conducted a retrospective study comparing 120 patients who had TB after renal transplantation (study group) with 440 patients without TB (control group). Both groups underwent transplantation during 1984-2003 in Iran.…”

Section: Tuberculosis and Transplantationmentioning

confidence: 99%

Renal Tuberculosis in the Modern Era

Daher¹,

Silva²,

Barros³

2013

The American Society of Tropical Medicine and Hygiene

114

View full text Add to dashboard Cite

Abstract. Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis. The disease remains as an important public health problem in developing countries. Extrapulmonary TB became more common with the advent of infection with human immunodeficiency virus and by the increase in the number of organ transplantation, which also leads to immunosuppression of thousand of persons. Urogenital TB represents 27% of extrapulmonary cases. Renal involvement in TB can be part of a disseminated infection or a localized genitourinary disease. Renal involvement by TB infection is underdiagnosed in most health care centers. Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria. The diagnosis of urinary tract TB is based on the finding of pyuria in the absence of common bacterial infection. The first choice drugs include isoniazide, rifampicin, pirazinamide, ethambutol, and streptomycin. Awareness of renal TB is urgently needed by physicians for suspecting this disease in patients with unexplained urinary tract abnormalities, mainly in those with any immunosuppression and those coming from TB-endemic areas.

show abstract

“…TB infection among renal transplant recipients presents important diagnostic difficulties because of the greater incidence of extrapulmonary involvement and the atypical presentation of the disease, specifically reactivation of the latent form, which more commonly occurs in the immunocompromised state (7). However, diagnosis of latent TB infection (LTBI) is problematic because the tuberculin skin test (TST), which has been extensively used for more than 100 years, has several limitations.…”

mentioning

confidence: 99%