1
|
Meinerz G, Silva CKD, Dorsdt DMB, Adames JB, Andrade JP, Ventura PE, Monteiro ADA, Pasqualotto AC, Garcia VD, Keitel E. Latent tuberculosis screening before kidney transplantation in the South of Brazil. J Bras Nefrol 2021; 43:520-529. [PMID: 33999988 PMCID: PMC8940112 DOI: 10.1590/2175-8239-jbn-2020-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.
Collapse
Affiliation(s)
- Gisele Meinerz
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| | - Cynthia Keitel da Silva
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| | | | - Julia Bertoni Adames
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Pedro Enrico Ventura
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Alessandro Comarú Pasqualotto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.,Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Valter Duro Garcia
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil
| | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Departamento de Nefrologia e Transplante de Rim e Pâncreas, Porto Alegre, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Patologia, Porto Alegre, RS, Brasil
| |
Collapse
|
2
|
Barbouch S, Hajji M, Helal I, Ounissi M, Bacha MM, Ben Hamida F, Abderrahim E, Ben Abdallah T. Tuberculosis After Renal Transplant. EXP CLIN TRANSPLANT 2017; 15:200-203. [PMID: 28260468 DOI: 10.6002/ect.mesot2016.p79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tuberculosis is one of the leading infections after renal transplant, particularly in developing countries where the incidence and prevalence in the general population are high. Diagnosis requires bacteriologic and histologic confirmation. Interactions among the antitubercular drugs and the immunosuppressive agents have to be considered while prescribing, and surveillance for adverse effects is required. Although rare, case reports are available on extrapulmonary tuberculosis in allograft recipients. Here, we present a 25-year-old kidney transplant recipient who was diagnosed with lymph node tuberculosis under uncommon circumstances but who had a good outcome. This case report illustrates the difficulties in diagnosis of tuberculosis, changes in therapeutic protocols, and prognostic factors and highlights the effects of infectious complications with immunosuppressive therapy in this particular patient population.
Collapse
Affiliation(s)
- Samia Barbouch
- Nephrology Department, Laboratory of Renal Pathology and Laboratory of Kidney Transplantation Immunology and Immunopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Meinerz G, da Silva C, Goldani J, Garcia V, Keitel E. Epidemiology of tuberculosis after kidney transplantation in a developing country. Transpl Infect Dis 2016; 18:176-82. [DOI: 10.1111/tid.12501] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/24/2015] [Accepted: 11/22/2015] [Indexed: 01/30/2023]
Affiliation(s)
- G. Meinerz
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - C.K. da Silva
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - J.C. Goldani
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - V.D. Garcia
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
| | - E. Keitel
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| |
Collapse
|
4
|
Mycobacterium tuberculosis infection following kidney transplantation. BIOMED RESEARCH INTERNATIONAL 2013; 2013:347103. [PMID: 24222903 PMCID: PMC3816022 DOI: 10.1155/2013/347103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022]
Abstract
Introduction and Aims. Post-transplant tuberculosis (TB) is a problem in successful long-term outcome of renal transplantation recipients. Our objective was to describe the pattern and risk factors of TB infection and the prognosis in our transplant recipients. Patients and Methods. This study was a retrospective review of the records of 491 renal transplant recipients in our hospital during the period from January 1986 to December 2009. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. Results. 16 patients (3,2%) developed post-transplant TB with a mean age of 32,5 ± 12,7 (range: 13–60) years and a mean post-transplant period of 36,6months (range: 12,3 months–15,9 years). The forms of the diseases were pulmonary in 10/16 (62,6%), disseminated in 3/16 (18,7%), and extrapulmonary in 3/16 (18,7%). Graft dysfunction was observed in 7 cases (43,7%) with tissue-proof acute rejection in 3 cases and loss of the graft in 4 cases. Hepatotoxicity developed in 3 patients (18,7%) during treatment. Recurrences were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Conclusion. Extra pulmonary and disseminated tuberculosis were observed in third of our patients. More than 9months of treatment may be necessary to prevent recurrence.
Collapse
|
5
|
Azevedo P, Freitas C, Silva H, Aguiar P, Farrajota P, Almeida M, Pedroso S, Martins LS, Dias L, Vizcaíno JR, Castro Henriques A, Cabrita A. A case series of gastrointestinal tuberculosis in renal transplant patients. Case Rep Nephrol 2013; 2013:213273. [PMID: 24558621 PMCID: PMC3914201 DOI: 10.1155/2013/213273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/26/2013] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.
Collapse
Affiliation(s)
- Pedro Azevedo
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Cristina Freitas
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Hugo Silva
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Pedro Aguiar
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Pedro Farrajota
- Department of Pathology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Manuela Almeida
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Sofia Pedroso
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - La Salete Martins
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Leonídio Dias
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - José Ramón Vizcaíno
- Department of Pathology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - António Castro Henriques
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - António Cabrita
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| |
Collapse
|
6
|
Marques IDB, Azevedo LS, Pierrotti LC, Caires RA, Sato VAH, Carmo LPF, Ferreira GF, Gamba C, de Paula FJ, Nahas WC, David-Neto E. Clinical features and outcomes of tuberculosis in kidney transplant recipients in Brazil: a report of the last decade. Clin Transplant 2013; 27:E169-76. [DOI: 10.1111/ctr.12077] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 02/04/2023]
Affiliation(s)
- Igor D. B. Marques
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Luiz S. Azevedo
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Lígia C. Pierrotti
- Department of Infectious Diseases; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Renato A. Caires
- Division of Nephrology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Víctor A. H. Sato
- Division of Nephrology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Lilian P. F. Carmo
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Gustavo F. Ferreira
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Cristiano Gamba
- Department of Infectious Diseases; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Flávio J. de Paula
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - William C. Nahas
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Elias David-Neto
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| |
Collapse
|
7
|
Ghafari A, Makhdoomi K, Ahmadpoor P, Afshari AT, Fallah MM, Rezaee K. Tuberculosis in Iranian Kidney Transplant Recipients: A Single-Center Experience. Transplant Proc 2007; 39:1008-11. [PMID: 17524876 DOI: 10.1016/j.transproceed.2007.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Renal transplantation recipients are at a high risk of developing tuberculosis (TB) following transplantation, especially in developing countries, with high incidences of morbidity and mortality. In this report, we examined the risk factors and impact of TB on the outcome of kidney transplantation. PATIENTS AND METHODS Among 1350 living donor Iranian kidney transplantations, 52 (3.9%) had TB diagnosed in various organs. Of these, 7 (13.5%) had TB pretransplantation and 40 (76.9%) were men. The overall mean age was 32.6 +/- 10.5 years. RESULTS The interval between transplantation and diagnosis was 54.6 +/- 48.23 (range 4 to 140) months. In 34 (65.6%) patients TB was diagnosed after the first year posttransplantation. Pleuro/pulmonary TB was the most common form (68%). All posttransplant TB patients received a quadriple antituberculosis therapy; pyrazinamide, rifampicin, ethambutol, and isoniazide). Hepatotoxicity was seen in 16 (30%) patients, including 12 mild cases with normalization after temporary withdrawal of isoniazide and rifampicin, and four were severe, but mortality was not attributable to hepatocellular failure. Twelve patients (23%) died. Chronic allograft dysfunction occurred in 34 (65%) patients, 19 (37%) with graft loss. Pre-TB patients showed comparable posttransplant courses. CONCLUSION TB is a common infection among renal transplant recipients in developing countries. The peak incidence is after the first year of transplantation and mortality is considerable. Hepatoxicity is a considerable risk of treatment, possibly as a result of additive toxic effects of immunosuppressive drugs. Chronic allograft nephropathy is a serious complication that has a negative impact on the graft survival.
Collapse
Affiliation(s)
- A Ghafari
- Department of Internal Medicine, Division of Nephrology, Urmia University of Medical Sciences, Urmia, Iran.
| | | | | | | | | | | |
Collapse
|
8
|
Biz E, Pereira CA, Moura LA, Sesso R, Vaz ML, Silva Filho AP, Pestana JO. The use of cyclosporine modifies the clinical and histopathological presentation of tuberculosis after renal transplantation. Rev Inst Med Trop Sao Paulo 2000; 42:225-30. [PMID: 10968886 DOI: 10.1590/s0036-46652000000400008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis is one of the most frequent opportunistic infections after renal transplantation and occurred in 30 of 1264 patients transplanted between 1976 and 1996 at Hospital São Paulo - UNIFESP and Hospital Dom Silvério, Brazil. The incidence of 2.4% is five times higher than the Brazilian general population. The disease occurred between 50 days to 18 years after the transplant, and had an earlier and worse development in patients receiving azathioprine, prednisone and cyclosporine, with 35% presenting as a disseminated disease, while all patients receiving azathioprine and prednisone had exclusively pulmonary disease. Ninety percent of those patients had fever as the major initial clinical manifestation. Diagnosis was made by biopsy of the lesion (50%), positivity to M. tuberculosis in the sputum (30%) and spinal cerebral fluid analysis (7%). Duration of treatment ranged from 6 to 13 months and hepatotoxicity occurred in 3 patients. The patients who died had a significant greater number of rejection episodes and received higher doses of corticosteroid. In conclusion, the administration of cyclosporine changed the clinical and histopathological pattern of tuberculosis occurring after renal transplantation.
Collapse
Affiliation(s)
- E Biz
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, 04038-002, Brasil
| | | | | | | | | | | | | |
Collapse
|