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Risk factors for post-transplant tuberculosis
G T John1, V Shankar, A M Abraham
1Department of Nephrology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. george@cmcvellore.ac.in
Kidney International
|September 5, 2001
Summary
Post-transplant tuberculosis (TB) is a significant concern in India, with cyclosporine therapy linked to early TB. Diabetes and liver disease are key risk factors for post-transplant TB and mortality.
Area of Science:
- Nephrology and Transplant Immunology
- Infectious Diseases Epidemiology
- Clinical Risk Factor Analysis
Background:
- Post-transplant tuberculosis (post-TxTB) affects 12-20% of patients in India, leading to a 20-25% mortality rate.
- Prospective studies investigating post-TxTB are limited, highlighting a need for further research.
Purpose of the Study:
- To prospectively evaluate the incidence, clinical manifestations, risk factors, and prognosis of post-TxTB in renal allograft recipients.
- To identify specific risk factors associated with the development and mortality of post-TxTB.
Main Methods:
- Prospective study of renal allograft recipients over a median of 3.1 years.
- Kaplan-Meier analysis for survival rates and extended Cox proportional models for time-dependent risk factors.
Main Results:
- Post-TxTB prevalence was 13.3%. Cyclosporine (CsA) therapy increased early post-TxTB risk (2.5x at <=6 months, 1.9x at <=12 months).
- Diabetes mellitus, chronic liver disease, and co-existing infections (e.g., CMV, PCP) were significant risk factors for post-TxTB.
- Mortality was associated with HLA mismatches, PRED + AZA immunosuppression, pre- and post-TxTB, diabetes, post-transplant diabetes (PTDM), and other infections.
Conclusions:
- Cyclosporine therapy is linked to early post-TxTB, while diabetes and liver disease are significant risk factors.
- The combination of pre- and post-TxTB, hyperglycemia, liver disease, and co-existing infections are critical determinants of mortality.