Tuberculosis in renal transplant recipients

Area of Science:

• Nephrology
• Infectious Diseases
• Transplantation Immunology

Background:

• Tuberculosis (TB) is a significant infectious complication in patients undergoing renal replacement therapy (RRT).
• Immunosuppression due to uremia and post-transplant medications increases TB risk in renal transplant recipients (RTRs).

Purpose of the Study:

• To examine the prevalence, clinical course, and outcomes of TB in RTRs.
• To compare TB occurrence in RTRs with patients on other RRT modalities (hemodialysis and continuous ambulatory peritoneal dialysis - CAPD).
• To discuss TB treatment protocols for this patient group.

Main Methods:

• Retrospective study analyzing all renal transplantation patients from 1989 to the present.
• Comparison of TB prevalence, age, and gender distribution across hemodialysis, CAPD, and RTR groups.
• Analysis of TB site of infection, outcomes, and co-infections in RTRs.

Main Results:

• No significant difference in TB prevalence, age, or male/female ratio was observed among hemodialysis, CAPD, and RTR groups.
• Pulmonary TB was more prevalent in hemodialysis patients (77.3%) compared to CAPD (30%) and RTRs (33.3%).
• No deaths due to TB occurred in RTRs; co-infections included cytomegalovirus (7 patients) and Aspergillus lung infection (3 patients).

Conclusions:

• TB affects patients across different RRT modalities similarly in terms of prevalence and demographics.
• While pulmonary TB is more common in hemodialysis, RTRs experience favorable outcomes with no TB-related mortality.
• Close monitoring for co-infections like CMV and fungal infections is crucial in RTRs with TB.