Tuberculosis following kidney transplantation: clinical features and outcome. A French multicentre experience in the last 20 years
- 5 April 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 26 (11), 3773-3778
- https://doi.org/10.1093/ndt/gfr156
Abstract
Kidney transplant recipients are at high risk of opportunistic infection. The aims of this study were to describe the epidemiology, clinical features and prognosis of Tuberculosis (TB) in kidney transplant recipients. Retrospective observational study conducted in 14 French transplant centres involving all cases of TB that occurred in kidney transplant recipients between 1986 and 2006. Among the 16146 kidney transplantations performed during the study period, 74 (0.45%) developed TB. The country of birth was a highly endemic area for TB in 20 (40.8%) patients. Time from kidney transplantation to TB was 10 months (4-27). Extrapulmonary and disseminated TB accounted for 33 (67.4%) cases. The most common symptoms were fever (71.7%), weight loss (41.3%) and asthenia (39.1%). Coexisting infections were diagnosed in 11 (22.4%) patients. Microbial sensitivity tests revealed no case of multidrug-resistant TB. Haemophagocytic syndrome associated with TB was diagnosed in 5 (10.2%) cases with 60% of mortality (P = 0.0005). Median length of antituberculous therapy was 12 (9.5-12) months. Immunosuppressive therapy was reduced in 22 (44.9%) patients without adverse consequence on the graft. Overall, hospital mortality was 6.1% and 1-year graft survival was 97%. Kidney transplantation increases the risk of TB, with a high rate of extrapulmonary disease. Symptoms of infection are often attenuated, leading to delayed diagnosis. Overall prognosis is good but haemophagocytic syndrome is associated with high mortality. Country of birth might be taken into account in the decision of post-transplantation treatment of latent TB.This publication has 41 references indexed in Scilit:
- Tuberculosis in Renal Transplant Recipients: The Evidence for ProphylaxisTransplantation, 2010
- Mycobacterium tuberculosis in Solid Organ Transplant RecipientsAmerican Journal of Transplantation, 2009
- The Influence of Deceased Donor Age and Old-for-Old Allocation on Kidney Transplant OutcomeTransplantation, 2009
- Tuberculosis in Solid‐Organ Transplant Recipients: Consensus Statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical MicrobiologyClinical Infectious Diseases, 2009
- Rituximab and Intravenous Immune Globulin for Desensitization during Renal TransplantationThe New England Journal of Medicine, 2008
- Malignancies in renal transplantation: an unmet medical needNephrology Dialysis Transplantation, 2007
- Familial and acquired hemophagocytic lymphohistiocytosisEuropean Journal of Pediatrics, 2006
- Mycobacterial infection in a series of 1261 renal transplant recipientsClinical Microbiology & Infection, 2003
- Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric TransplantThe New England Journal of Medicine, 1999
- THE HIGH INCIDENCE OF TUBERCULOSIS AMONG RENAL TRANSPLANT RECIPIENTS IN INDIATransplantation, 1996