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Related Experiment Videos

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
PubMed
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.

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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.

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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.