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Mycobacterium tuberculosis infections after renal transplantation
S Apaydin1, M R Altiparmak, K Serdengeçti
1Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul, Turkey.
Abstract:
The incidence of tuberculosis was found to be 5.8% (16/274) in 274 kidney graft recipients in our centre between 1986 and 1998. The kidney recipients were evaluated retrospectively. A total of 51 recipients received isoniazid prophylaxis for 6 months. The prevalence of tuberculosis was found similar (6% vs. 8.8%, p = 0.15) between recipients with prophylaxis and no prophylaxis. Eight patients were recipients of cadaveric donor kidneys and 8 were recipients of living donor kidneys. Lungs were the most frequently affected site, as in the normal population. M. tuberculosis grew in 7 patients. In 5 patients, M. tuberculosis was also detected on direct microscopy and polymerase chain reaction. In 4 patients, diagnosis was made on clinical grounds and later confirmed by positive response to therapy. In 8 patients, invasive procedures were performed for diagnosis. Five patients had miliary tuberculosis at the time of diagnosis. In 3 patients dissemination occurred during follow-up. Nine patients responded to anti-tuberculous therapy while still preserving their graft function, 1 patient rejected the graft while under treatment and returned to haemodialysis. Five patients (31%) died. Since the risk of dissemination of tuberculosis is high in these patients, anti-tuberculous therapy should be started whenever clinical findings suggestive of tuberculosis are present, even in the absence of any microbiological and/or histological evidence.
Insights
Tuberculosis incidence in kidney transplant recipients was 5.8%. Prophylaxis did not significantly alter prevalence, but early treatment is crucial due to high dissemination risk in these patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Kidney transplant recipients face increased risks of opportunistic infections, including tuberculosis.
- Understanding tuberculosis incidence and outcomes in this population is vital for patient management.
Purpose of the Study:
- To determine the incidence of tuberculosis in kidney graft recipients.
- To evaluate the effectiveness of isoniazid prophylaxis.
- To analyze clinical presentation, diagnosis, and outcomes of tuberculosis in this cohort.
Main Methods:
- Retrospective evaluation of 274 kidney graft recipients between 1986 and 1998.
- Analysis of tuberculosis incidence, prophylaxis use, affected sites, diagnostic methods, and treatment outcomes.
- Comparison of tuberculosis prevalence between recipients with and without isoniazid prophylaxis.
Main Results:
- Tuberculosis incidence was 5.8% (16/274).
- Isoniazid prophylaxis showed no significant difference in tuberculosis prevalence (6% vs. 8.8%, p=0.15).
- Lungs were the most common site; 31% of patients died, and graft rejection occurred in one patient.
Conclusions:
- Tuberculosis is a significant concern in kidney transplant recipients.
- Early initiation of anti-tuberculous therapy is recommended based on clinical suspicion, even without microbiological confirmation, due to high dissemination risk.
- Prophylaxis with isoniazid did not significantly reduce tuberculosis incidence in this study cohort.