Introduction: Tuberculosis infection (TB) increases morbidity and mortality after kidney transplantation (TX) and poses diagnostic and therapeutic challenges. The incidence of TB among solid organ transplant depends on its incidence in the general population. Endemic countries have a higher incidence of TB (> 25 cases per 105 inhabitants) compared to developed countries, but little is known regarding this infection among kidney transplant recipients.
Objective: The aim of this study is to determine the incidence, demographic characteristics, clinical and/or microbiological features and outcomes of TB in a single center kidney TX program over a 10-year period of time.
Methods: This retrospective cohort study analyzed data of kidney TX performed between January 1st 2002 and October 31st, 2012. TB was diagnosed by the presence of acid-fast bacilli on sputum smear, histological findings and/or positive culture. Disseminated TB was defined when two or more organs were compromised.
Results: Of 7335 kidney transplants performed during this period, there were 73 cases of TB (995 cases per 105 recipients). Mean age of this population was 40±13y, being 67% male, 76% recipients of first transplant and 51% from living donor. Median time to develop TB was 33 months post transplantation. Extra pulmonary TB represented 48% of the cases, pulmonary 37%, disseminated 11% and in 4% presumed due to prolonged fever from unknown origin (3 cases). There were histological positive findings in 84% of cases and positive culture in 64%. Sputum smears were positive in 32% of pulmonary cases. All patients were treated for at least 6 months with a triple regimen (izoniazid, rifampin and pyrazinamide), plus ethambutol in cases diagnosed after 2010. Attributed mortality was 18%. Graft loss occurred in 21% of survivors (9 cases of acute rejection and 6 cases of chronic allograft dysfunction).
Conclusions: TB incidence in kidney transplanted recipients was 28 times higher than in the general population. Most cases had extra pulmonary presentation, which poses considerable diagnosis difficulties. TB has an important social and economical impact, since it affected young recipients from mostly live donors, was associated with high incidence of mortality and graft loss.
To cite this abstract in AMA style:Viana L, Cristelli M, Tavares M, Dantas M, Felipe C, Oliveira N, Paula M, Miranda S, Franco M, Tedesco H, Medina- J. Tuberculosis in Kidney Transplant – 10 Years Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/tuberculosis-in-kidney-transplant-10-years-experience/. Accessed September 21, 2017.
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