Donor-derived TB after kidney transplantation: a case report

Area of Science:

• Nephrology
• Transplant Surgery
• Infectious Diseases

Background:

• Tuberculosis (TB) poses a significant risk of mortality and morbidity following solid organ transplantation.
• Preventing post-transplant TB is paramount, though treatment is complicated by drug toxicity and immunosuppressant interactions.

Observation:

• A kidney transplant recipient presented with fever, miliary TB, and graft fistulization 37 days post-surgery.
• Diagnosis was confirmed by positive acid-fast bacilli (AFB) in drained fluid and urine culture for Mycobacterium tuberculosis.
• The contralateral kidney recipient also developed post-transplant TB, suggesting donor-derived transmission.

Findings:

• The patient received a four-drug anti-TB regimen (rifampicin, isoniazid, pyrazinamide, ethambutol) with a positive clinical response.
• Graft function was preserved throughout the treatment course.
• Donor-derived TB transmission is a critical consideration in paired recipients.

Implications:

• TB should be a key differential diagnosis for infectious complications in transplant recipients, particularly in endemic areas.
• Unspecific symptoms like fever and fluid collections warrant high suspicion for TB.
• Early diagnosis and appropriate management are vital for favorable outcomes in post-transplant TB.