Related Experiment Video
Updated: Oct 20, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
TB in paediatric kidney transplant recipients - A single-centre experience
Privilage D Makanda-Charambira1, Peter Nourse1, Valerie A Luyckx2
1Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Insights
Tuberculosis (TB) poses a significant risk to pediatric kidney transplant recipients in endemic areas. Isoniazid (INH) prophylaxis effectively protects these vulnerable patients from developing TB, ensuring better outcomes.
Area of Science:
- Pediatric Nephrology
- Transplant Infectious Diseases
- Public Health in Endemic Regions
Background:
- Tuberculosis (TB) presents a substantial clinical challenge for pediatric kidney transplant recipients, especially in countries where TB is prevalent.
- Understanding the incidence, clinical manifestations, and outcomes of TB in this immunocompromised population is crucial for effective management.
Purpose of the Study:
- To determine the incidence, clinical presentation, and outcomes of tuberculosis in pediatric kidney transplant recipients.
- To evaluate the protective effect of isoniazid (INH) prophylaxis against tuberculosis development in this cohort.
Main Methods:
- A single-center, retrospective descriptive analysis was conducted on pediatric patients who underwent kidney transplantation between 1995 and 2019.
- The study cohort was divided based on the initiation of isoniazid (INH) prophylaxis in 2005 to assess its impact.
Main Results:
- Tuberculosis was diagnosed in 9% (20/212) of pediatric kidney transplant recipients, with most cases occurring within the first year post-transplant.
- Pulmonary TB was the most common form, with fever, weight loss, and cough as primary symptoms. Isoniazid (INH) prophylaxis demonstrated a protective effect against TB development (p=0.04).
- Management of TB required increased immunosuppression drug doses due to drug interactions, but graft and patient survival reached 100% after treatment completion.
Conclusions:
- Pediatric kidney transplant recipients in TB-endemic regions face a high risk of developing tuberculosis, necessitating vigilant diagnosis and management.
- Isoniazid (INH) prophylaxis is a key strategy for preventing tuberculosis in this high-risk population.
- Close monitoring of immunosuppression drug levels is essential during TB treatment to prevent graft loss.
Background:
TB remains a major challenge in transplantation, particularly in endemic countries. This study aimed to describe the incidence, clinical presentation and outcomes of TB in paediatric kidney transplant recipients and to assess the impact of INH prophylaxis.
Methods:
Single-centre retrospective descriptive analysis of children who received kidney transplants from 1995 to 2019 was carried out. The cohort was stratified according to receipt of INH prophylaxis which began in 2005.
Results:
A total of 212 children received a kidney transplant during the study period. Median age at transplantation was 11.2 years (IQR: 2.2-17.9), and 56% were males. TB was diagnosed in 20 (9%) children, with almost two-thirds (n = 12) occurring within the first year. Most infections were pulmonary. The main presenting symptoms included fever (n = 13/20), weight loss (n = 12/20) and cough (n = 10/20). TST was positive in four of 20 children. Coinfection with EBV, CMV or Staph was found in five children. Due to drug interactions, an up to threefold increase in calcineurin inhibitor dose was required to maintain therapeutic blood levels. INH prophylaxis was protective against development of TB (p = .04). Gender, age and type of allograft were not significant risk factors. Graft and patient survival was 100% upon completion of TB treatment.
Conclusion:
Kidney transplant recipients in endemic countries have a high risk of developing TB. Diagnosis remains a challenge. Frequent and meticulous monitoring of immunosuppression drug levels during treatment of TB is required to avoid loss of patient or graft. INH prophylaxis protects against development of TB in this population.
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