Tuberculosis in Renal Transplant Recipients

Mycobacterium Tuberculosis Infection after Kidney Transplantation: A Comprehensive Review

Tuberculosis (TB) in kidney transplant (KT) recipients is an important opportunistic infection with higher incidence and prevalence than in the general population and is associated with important morbidity and mortality. We performed an extensive literature review of articles published between 1 January 2000 and 15 June 2022 to provide an evidence-based review of epidemiology, pathogenesis, diagnosis, treatment and outcomes of TB in KT recipients. We included all studies which reported epidemiological and/or outcome data regarding active TB in KT, and we approached the diagnostic and treatment challenges according to the current guidelines. Prevalence of active TB in KT recipients ranges between 0.3–15.2%. KT recipients with active TB could have a rejection rate up to 55.6%, a rate of graft loss that varies from 2.2% to 66.6% and a mortality rate up to 60%. Understanding the epidemiological risk, risk factors, transmission modalities, diagnosis and treatment challenges is critical for clinicians in providing an appropriate management for KT with TB. Among diagnostic challenges, which are at the same time associated with delay in management, the following should be considered: atypical clinical presentation, association with co-infections, decreased predictive values of screening tests, diverse radiological aspects and particular diagnostic methods. Regarding treatment challenges in KT recipients with TB, drug interactions, drug toxicities and therapeutical adherence must be considered.

Intestinal Tuberculosis Presenting as an Ileocecal Mass in a Renal Transplant Patient

Abdominal tuberculosis accounts for approximately 5% of tuberculosis cases. However, recognition of this entity can be challenging in the absence of concomitant pulmonary involvement. Immunocompromised and immunosuppressed patients are at elevated risk for this infection and are confronted with increased side effects, drug interactions, and disease complications. We report the case of a 53-year-old female renal transplant recipient with a remote history of tuberculosis exposure who presented with sepsis and abdominal pain and was found to have an obstructive ileocecal mass. Serologic and pathologic testing ultimately led to the diagnosis of abdominal tuberculosis, and she was treated successfully with a course of antimycobacterial therapy with only minor complications.

Mycobacterium tuberculosis after solid organ transplantation: A review of more than 2000 cases

BACKGROUND

Mycobacterium tuberculosis (TB) is a common pathogen worldwide, and it may cause significant infection after solid organ transplantation (SOT). We reviewed all reported TB cases to provide an update on its epidemiology, clinical presentation, management, and outcome after SOT.

METHODS

MEDLINE, EMBASE, and OVID were reviewed from January 1, 1998, to December 31, 2016, using keywords tuberculosis and solid organ transplant or transplantation.

RESULTS

There were 187 publications reporting 2082 cases of TB among kidney (n = 1719), liver (n = 253), heart (n = 77), lung (n = 25), and kidney-pancreas (n = 8) recipients. Among cohort studies, the median incidence was 2.37% (range, 0.05%-13.27%) overall. Most TB disease was considered reactivation of latent infection, occurring beyond the first year after SOT. Early-onset cases were seen among donor-derived TB cases. Fever was the most common symptom. Radiologic findings were highly variable. Extrapulmonary and disseminated TB occurred 29.84% and 15.96%, respectively. Multidrug-resistant TB was rare. Treatment using 4 or 5 drugs was commonly associated with hepatotoxicity and graft dysfunction. All-cause mortality was 18.84%.

CONCLUSIONS

This large review highlights the complexity of TB after SOT. Reactivation TB, donor-transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction.

Tuberculosis After Renal Transplant

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.

Infections in renal transplant patients: risk factors and infectious agents

AIM

Infectious complications after renal transplantation (RT) are associated with significant morbidity. They continue to be the most frequent cause of mortality. We investigated the incidence of infections, the causative pathogens, and risk factors contributing to this complication during the first year.

PATIENTS AND METHODS

We included demographic and clinical data of the 124 patients who underwent RT in our hospital from December 2004 to June 2010. for statistical analysis.

RESULTS

Fifty (40.3%) RT recipients developed 80 episodes of infection: urinary tract (n = 68; 85%), intraabdominal (n = 4; 5%), surgical wound (n = 3; 3.8%), or central venous catheter (n = 3; 4%). Eight (10%) were bacteremic. The most commonly isolated bacteria scene (76/80) was Escherichia coli (n = 43; 56.5%) followed by Klebsiella spp. (n = 10; 13.2%) and Pseudomonas spp. (n = 10; 13.2%). Cytomegalovirus infection was detected in 2 recipients; fungal and mycobacterial infections, in no case. It was noteworthy that 52.8% of E. coli and Klebsiella spp. produced extended-spectrum beta-lactamase. Ninety percent of infections developed within 6 months after transplantation. When we compared infected versus noninfected cases, the presence of a double J catheter was the most significant risk factor (P = .018; odds ratio [OR] = 0.234; 95% confidence interval [CI] = 0.070-0.781). In contrast to the initial years after the start of RT in our hospital the incidence of infection decreased over time together with a decrease number and durations of catheterization (P = .008; OR = 2.707; 95% CI = 1.292-5.672).

CONCLUSIONS

Urinary tract infections were the predominant problem with most isolates resistant to extended-spectrum antibiotics. Therefore, invasive catheters and prophylactic antibiotics should not be used for longer than necessary and infection control measures implemented to decrease the incidence of infections and bacterial resistance.

Clinical characteristics and treatment responses of patients who developed tuberculosis following use of a tumor necrosis factor-α inhibitor

BACKGROUND/AIMS

Individuals being treated with tumor necrosis factor (TNF)-α inhibitors are at increased risk of developing tuberculosis (TB). We determined the clinical characteristics and treatment response of patients who developed TB after using TNF-α inhibitors.

METHODS

Patients with TB detected within 12 months of the initiation of TNF-α inhibitor treatment were included, if seen from January 1, 2000 to August 31, 2011. We retrospectively reviewed the clinical records, results of bacteriological examinations, and radiographs of the included patients and the response to anti-TB treatment.

RESULTS

We indentified seven cases of TB in 457 patients treated with TNF-α inhibitors during the study period. TB developed a median of 123 days (range, 48 to 331) after the first dose of TNF-α inhibitor. Pulmonary TB, including TB pleuritis, was diagnosed in three patients and extrapulmonary TB in four. Favorable treatment outcomes were achieved in six of seven patients.

CONCLUSIONS

Among the TNF-α inhibitor users who contracted TB, extrapulmonary sites were common and the treatment response was satisfactory.