Background: Most cases of Tuberculosis (TB) in solid organ transplant recipients are caused by reactivation of a latent infection after initiation of immunosuppressive therapy. This study aims to assess incidence, clinical manifestations and clinical outcomes of TB following renal transplantation in endemic country.

Methods:A retrospective cohort study was conducted in Chulalongkorn hospital, Bangkok, Thailand and all medical records of adult recipients who underwent renal transplant between 1998 – 2014 were reviewed. The collected data included demographic information, clinical manifestations, immunosuppressive regimens, diagnostic methods for TB, treatment and clinical outcomes.

Result:A total of 446 renal transplant recipients were enrolled. None of them received isoniazid for treatment of latent infection or prophylaxis after renal transplantation. TB was diagnosed in 19 cases. The incidence of TB was 4.26% and 266.3 per 1000,000 person year and median time to diagnosis was 36.81 months (range 1-152 months) after transplant. Majority of patients were cadaveric renal transplantation recipients (73.18%) and did not receive induction therapy (58%). The common maintenance immunosuppressive agents were cyclosporine A, prednisolone, mycophenolate mofetil and tacrolimus.

Pulmonary TB was the most common manifestation (57.9%) followed by disseminated TB (31.6%) and extra-pulmonary TB (10.5%). Eight of 19 patients (42.1%) had positive culture and all were pan-drug susceptible. Thirteen of 19 patients (68.42%) developed TB after 1 year post-transplantation which 7 of 13 patients (56.84%) had TB after treatment of allograft rejection. In term of clinical outcomes, graft loss was found in 26.3% and all-cause mortality rate of patients with TB was 21%.

Conclusion: The incidence of TB after renal transplantation is relatively low compared the reported from other endemic country. Majority of cases developed TB after the first transplant year which may represent acquired infection rather than reactivation. Therefore, newly exposure of Mycobacterium tuberculosis post-transplantation should be considered as an important risk of active TB in endemic area especially those who received anti-rejection therapy.

CITATION INFORMATION: Jutivorakool K, Vanichanan J, Suwanpimolkul G, Avihingsanon Y, Townamchai N. Incidence and Clinical Outcomes of Mycobacterium tuberculosis Infections Following Renal Transplantation in Endemic Country. Am J Transplant. 2017;17 (suppl 3).

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