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Published on: April 12, 2021
Kidney transplantation in patients on anti-tubercular therapy: A single centre observational study
Pallavi Prasad1, Sahil Bagai2, Vandana Prasad2
1Department of Nephrology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Background:
Tuberculosis (TB) is a common infection in chronic kidney disease. The prolonged therapy of TB can delay kidney transplantation in patients on antitubercular therapy (ATT).
Methods:
This was a retrospective single-center study to analyze the safety of kidney transplantation and its outcomes in patients undergoing transplantation while on the continuation phase of ATT.
Results:
Between 2013 and 2022, 30 patients underwent kidney transplantation while on ATT. Median age was 38 years and 70% were males. Majority of the patients (86.7%) had extrapulmonary tuberculosis, most common site of involvement being tubercular lymphadenitis. 14/30 patients had microbiological/histopathological diagnosis of TB and the rest were diagnosed by ancillary tests. Patients were treated with 4 drug ATT (isoniazid, rifampicin, pyrazinamide, ethambutol) before transplantation for aminimum of 2 months. Post-transplantation fluoroquinolone-based non-rifamycin ATT was used (median duration 11 months). All patients completed therapy. At 2 years, there was 100% patient survival and 96.7% graft survival. Median eGFR at 6, 12, and 24 months post-transplantation was 71.9, 64.7, and 67 mL/min/1.73m2, respectively. The percentage of patients suffering a biopsy proven acute rejection at 6, 12, and 24 months was 3.3%, 6.7%, and 6.7%.
Conclusion:
Kidney transplantation can be done in patients with TB who have a satisfactory response to the intensive phase of the ATT. The decision for transplantation while on the continuation phase of ATT should be individualized. In our experience, there is excellent patient and graft survival in these patients with a low risk of failure of ATT or relapse of TB.
Insights
Kidney transplantation is safe for patients with tuberculosis (TB) undergoing treatment. Kidney transplant recipients on antitubercular therapy (ATT) showed excellent survival rates and graft function, with a low risk of TB relapse.
Area of Science:
- Nephrology
- Transplantation Immunology
- Infectious Diseases
Background:
- Tuberculosis (TB) is a significant comorbidity in patients with chronic kidney disease (CKD).
- Antitubercular therapy (ATT) can prolong the time to kidney transplantation for TB patients.
- Managing TB in CKD patients requires careful consideration for immunosuppression post-transplant.
Purpose of the Study:
- To evaluate the safety and outcomes of kidney transplantation in patients undergoing the continuation phase of ATT.
- To assess patient and graft survival rates in kidney transplant recipients with active or recent TB.
- To determine the incidence of acute rejection and graft function in this patient cohort.
Main Methods:
- Retrospective, single-center study analyzing 30 kidney transplant recipients on ATT.
- Patients received a 4-drug ATT (isoniazid, rifampicin, pyrazinamide, ethambutol) for at least 2 months pre-transplant.
- Post-transplant, a fluoroquinolone-based, non-rifamycin ATT was administered for a median of 11 months.
Main Results:
- Excellent 2-year patient survival (100%) and graft survival (96.7%) were observed.
- Median estimated glomerular filtration rate (eGFR) at 24 months was 67 mL/min/1.73m².
- Low rates of biopsy-proven acute rejection at 2 years (6.7%) and no reported ATT failure or TB relapse.
Conclusions:
- Kidney transplantation is a viable option for TB patients with a positive response to ATT.
- Individualized assessment is crucial for deciding transplantation during the continuation phase of ATT.
- This study demonstrates excellent outcomes, supporting the safety of kidney transplantation in patients on ATT.
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