Diagnosis and treatment of tuberculosis in renal transplant recipients: a single-center retrospective sTUDY

Tuberculosis is a serious infectious complication after kidney transplantation. The aim of this study is to assess the incidence of tuberculosis in renal transplant recipients with the use of different protocols of immunosuppression, clinical features of tuberculosis, character of antituberculosis therapy and complications of treatment, outcomes of tuberculosis. Our retrospective study included 907 patients (1084 transplantations), who were transplanted from January 1987 to December 2003. We used 5 protocols of immunosuppression: in 28 patients - CsA 17 mg/kg + corticosteroids, CS (protocol I), in 366 - CsA 10-12 mg/kg + CS (II), in 210 - CsA 6 mg/kg + CS + Aza (III), in 310 - CsA 2-4 mg/kg + CS + Aza + ketoconazole (IV), in 80 - CsA 4 mg/kg + CS + MMF + ketoconazole (V). Tuberculosis developed in 27 (2,98%) patients. The mean patient age at transplantation was 37,1 ± 2,1 years. Median interval from transplantarion to development of tuberculosis was 869 days (range 14-3140 days). There were no differences in prevalence of tuberculosis in patients received different protocols of immunosuppression: 3,6% (I), 1,4% (II), 3,8% (III), 3,5% (IV), 2,5% (V), p = 0,201. Pulmonary tuberculosis was the most common form of the desease - 70,4%. Extrapulmonary forms developed in 7,4%. The total incidence of disseminated tuberculosis was 37,0%. Mortality rate from tuberculosis was 90,0% in patients with disseminated desease and 12,5% - with local tuberculosis. In 22,2% of patients the lung involvement was revealed only with X-ray CT. Survival rate of recipients with tuberculosis was higher on the treatment of 4-5 antituberculosis drugs. We observed hepatic dysfunction in 20% of patients treated with antituberculosis therapy, decrease of CsA blood level - in 95% of patients received rifampin. To our mind, an aggressive diagnostic approach and adequate treatment can improve outcome of tuberculosis in renal transplant recipients.

туберкулез, трансплантация почки, иммуносупрессия

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