Pre-transplant risk factors for tuberculosis after kidney transplant in an intermediate burden area

To examine pre-transplant risk factors for the development of post-kidney transplant tuberculosis (TB) in an intermediate TB burden country, as this is important for early detection and prophylaxis to prevent post-transplant TB.

A retrospective, longitudinal cohort study of 1097 kidney transplant patients was performed at the Severance Hospital, Seoul, South Korea, between January 2000 and March 2010. The standardised incidence ratio (SIR) of post-transplant TB compared to the general population was calculated and pre-transplant risk factors were analysed.

Among the 1097 kidney transplant patients, 2.1% (23/1097) developed post-transplant TB, with an incidence of 445.2 cases per 100,000 patients per year. The SIR of TB in kidney transplant patients compared with the general population was 4.26 (95%CI 2.6-6.45). A positive tuberculin skin test (TST; RR 3.54, 95%CI 1.13-11.11, P = 0.03) and previously healed TB on chest radiograph (CXR; RR 8.71, 95%CI 1.00-75.84, P = 0.05) were significant pre-transplant risk factors for post-transplant TB on multivariate analysis.

The incidence of TB in kidney transplant patients was higher than in the general population. Positive TST results and previously healed TB lesions visible on pre-transplant CXR were significant pre-transplant risk factors for post-kidney transplant TB.