Mycobacterium tuberculosis Infection in Renal Transplant Recipients

doi:10.1016/j.transproceed.2006.03.029

Transplantation Proceedings

Volume 38, Issue 5, June 2006, Pages 1344-1345

https://doi.org/10.1016/j.transproceed.2006.03.029 Get rights and content

Abstract

Mycobacterium tuberculosis (TB) infection is more common among renal allograft recipients compared with the general population due to immunosuppression. The epidemiological risk in a country is an important determinant of transplant TB after transplantation. We retrospectively analyzed 283 renal transplant recipients who underwent renal transplantation between 1990 and 2004. We evaluated the incidence, patient and disease characteristics, prognosis, and outcome of TB infection. Tuberculosis developed in 10 (seven men and three women of mean age of 41 ± 9 years) among 283 patients (3.1%). All patients were culture-positive for M tuberculosis. Although pulmonary TB was the most common presentation in the general population, 50% of patients in the study group developed extrapulmonary TB. The mean elapsed time from renal transplantation was 38 months. Three patients (1%) developed TB in the first year after transplantation. All patients were treated with a quartet of anti-TB therapy. One patient developed isoniazid-related reversible hepatotoxicity. No acute allograft rejection occurred during the anti-TB therapy. Two patients (20%) with pulmonary TB died due to dissemination of the disease. In conclusion, extrapulmonary presentations of TB are more common among renal transplant recipients with the increased risk of mortality.

Section snippets

Patients and methods

We retrospectively analyzed 283 renal allograft recipients who underwent kidney transplantation between 1990 and 2004. Forty-four had received a cadaveric (15.5%) and 239 of them, a living related (84.5%) allograft. The diagnosis of TB was based on microbiological growth in a culture of Lowenstein-Jensen medium. All patients had immunosuppression including corticosteroid + azathioprine/mycophenolate mofetil + cyclosporine/tacrolimus. Cadaveric allograft recipients also received antithymocyte

Results

TB was diagnosed in 10 of 283 kidney allograft recipients (3.5%). The mean age of the study population was 30 ± 10 years, whereas it was 41 ± 9 years in the TB infection group (P > .05). Tuberculosis developed in seven men and three women patients. Two of them were recipients of cadaveric and eight of living related transplantations. The causes of chronic renal failure were glomerulonephritis in four patients, interstitial renal diseases in two patients, and other diseases/unknown etiologies in

Discussion

TB is a serious infection associated with a high risk of mortality after renal transplantation. Due to improved living conditions, TB incidence is lower in industrialized countries than in developing countries. The annual case rate in the United States³ was 5.1 per 100,000, while it was 168 per 100,000 in India.⁴ The epidemiological risk in a country determines the risk of developing TB after transplantation. Similar to the general population the reported incidence of posttransplant TB was

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Prevalence of active tuberculosis infection in transplant recipients: A systematic review and meta-analysis
2020, Microbial Pathogenesis
Citation Excerpt :
Eight studies included populations in Taiwan [28–35]. Five studies were conducted in India [36–40] and [41,42], Turkey [43–45]. Four studies were done in China [29,46–48].
Tuberculosis (TB) is considered as a serious complication of organ transplant; therefore, the detection and appropriate treatment of active TB infection is highly recommended for the reduction of mortality in the future. The aim of this review was to conduct a systematic review and meta-analysis assessing the prevalence of active TB infection in transplant recipients (TRs).
Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched up to December 24, 2017. The prevalence of active TB was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 14.
The pooled prevalence of post-transplant active TB was estimated 3% [95% CI: 2–3]. The pooled prevalence of active TB in different transplant forms was as follows: renal,3% [95% CI: 2–4]; stem cell transplant (SCT), 1% [95% CI: 0–3]; lung, 4% [95% CI: 2–6]; heart, 3% [95% CI: 2–4]; liver, 1% [95% CI: 1], and hematopoietic stem cell transplant (HSCT), 2% [95% CI: 1–3]. The prevalence of different clinical presentations of TB was as follows: pulmonary TB (59%; 95% CI: 54–65), extra pulmonary TB (27%; 95% CI: 21–33), disseminated TB (15%; 95% CI: 12–19) and miliary TB (8%; 95% CI: 4–13). The pooled prevalence of different diagnostic tests was as follows: chest X-ray, 57% [95% CI, 46–67]; culture, 56% [95% CI, 45–68]; smear, 49% [95% CI, 40–58]; PCR, 43% [95% CI, 40–58]; histology, 26% [95% CI, 20–32], and tuberculin skin test, 19% [95% CI, 10–28].
A high suspicion level for TB, the early diagnosis and the prompt initiation of therapy could increase the survival rates among SOT patients. Overall, renal and lung TRs appear to have a higher predisposition for acquiring TB than other type of recipients. Monitoring of the high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection among TRs especially in endemic areas.
Preventive therapy for latent tuberculosis infection—the promise and the challenges
2017, International Journal of Infectious Diseases
Around one third of the world's population may harbour latent tuberculosis infection (LTBI), an asymptomatic immunological state that confers a heightened risk of subsequently developing tuberculosis (TB). Effectively treating LTBI will be essential if the End TB Strategy is to be realized. This review evaluates the evidence in relation to the effectiveness of preventive antibiotic therapy to treat LTBI due to both drug-susceptible and drug-resistant bacteria. Current national and international preventive therapy guidelines are summarized, as well as ongoing randomized trials evaluating regimens to prevent drug-resistant TB. Populations that may benefit most from screening and treatment for LTBI include close contacts of patients with TB (particularly children under 5 years of age) and individuals with substantial immunological impairment. The risks and benefits of treatment must be carefully balanced for each individual. Electronic decision support tools offer one way in which clinicians can help patients to make informed decisions. Modelling studies indicate that the expanded use of preventive therapy will be essential to achieving substantial reductions in the global TB burden. However, the widespread scale-up of screening and treatment will require careful consideration of cost-effectiveness, while ensuring the drivers of ongoing disease transmission are also addressed.
Mycobacterial infections in solid organ transplant recipients
2014, Clinical Microbiology and Infection
Citation Excerpt :
Tuberculosis-related mortality in SOT recipients has been reported to be as high as 40% [14,15]. Although this mortality rate may have decreased due to better diagnostic techniques, it remains high (9.5–17%) [2,10]. In addition, there are no reports of the mortality rate in Eastern European countries, where the prevalence of TB is high.
Mycobacterial infections represent a growing challenge for solid organ transplant recipients (SOT). The adverse effects of tuberculosis (TB) therapy present a major difficulty, due to the interactions with immunosuppressive drugs and direct drug toxicity. While TB may be donor-transmitted or community-acquired, it usually develops at a latent infection site in the recipient. Pre-transplant prevention efforts will improve transplant outcomes and avoid the complications associated with post-transplant diagnosis and treatment. The present review and consensus manuscript is based on the updated published information and expert recommendations. The current data about epidemiology, diagnosis, new regimens for the treatment of latent TB infection (LTBI), the experience with rifamycins for the treatment of active TB in the post-transplant period and the experience with isoniazid for LTBI in the liver transplant population, are also reviewed. We attempt to provide useful recommendations for each transplant period and problem concerning mycobacterial infections in SOT recipients.
Kidney transplantation in developing countries
2013, Kidney Transplantation-Principles and Practice, Seventh Edition
Clinical features and outcomes of tuberculosis in solid organ transplant recipients
2012, Transplantation Proceedings
Citation Excerpt :
Earlier development of TB after transplantation has been associated with clinical or radiological evidence of TB prior to transplantation and more severe immunosuppression.1,3 Although pulmonary TB occurs in 50% to 60% of SOT recipients, disseminated forms are frequently evident among 24% to 50% of this population.1,2,5,9 Similarly to previously reported data, 39% of our SOT recipients with TB presented with disseminated disease.
Tuberculosis (TB) remains a significant opportunistic infection in solid organ transplant (SOT) recipients. Moreover, its optimal treatment in SOT recipients is challenging due to the toxicity and potential drug-drug interactions of antituberculus drugs. We sought to assess the frequency, clinical characteristics, treatments, and outcomes of TB among SOT recipients.
We reviewed retrospectively the medical charts of all TB cases occurring among SOT recipients from January 2000 to December 2011, retrieving data regarding baseline and clinical features, as well as treatment and outcomes.
Eighteen of 2005 SOT recipients developed TB (0.9%). The frequency according to the type of allograft was 0.9% (10 of 1120) for kidney, 1% (7 of 701) for liver, and 0.5% (1 of 184) for heart recipients. Six patients (33%) had prior exposure to TB: a positive tuberculin test (n = 3), a positive quantiferon-TB (n = 1) for a prior history of TB (n = 3). None of them received antituberculus prophylaxis. The mean time after transplantation to TB diagnosis was 64 months (range 2–169). Five patients (28%) developed TB within the first year posttransplantation. The mean duration of symptoms before diagnosis was 30 days (range 1–180). Nine patients (50%) displayed pulmonary TB; 7 (39%) had disseminated infections, and 2 (11%) had lymph node involvement. None of the Mycobacterium tuberculosis isolates were resistant to first-line antituberculus drugs. All patients were given isoniazide. Most of them received a 3-drug regimen. Rifampin was prescribed in 11 cases. Seven patients (5 liver and 2 kidney recipients) developed hepatotoxicity. One patient developed rejection without allograft loss. Mortality during antituberculus treatment was 17% (3/18).
In this study, 0.9% of SOT recipients developed TB, which frequently presented with extrapulmonary involvement, causing considerable mortality. Hepatotoxicity mainly among liver transplant recipients was a significant therapeutic drawback.
Treatment of latent tuberculosis infection
2012, Revue des Maladies Respiratoires
L’intérêt pour l’infection tuberculeuse latente (ITL) s’est accentué depuis les années 2000 en raison de sa revalorisation comme une étape clef dans la physiopathologie de la tuberculose et dans la stratégie de prévention de cette maladie. Son traitement est bien codifié dans les recommandations de plusieurs pays. Dans cette revue nous développons les conditions pour optimiser le traitement préventif : choisir les sujets ayant le meilleur rapport bénéfice/risque, surveiller et prévenir les complications du traitement, mettre en jeu une éducation thérapeutique et intégrer le traitement des ITL dans l’arsenal complet de la lutte antituberculeuse.
Latent tuberculosis infection is a key stage in the natural history of tuberculosis, and provides an important period where strategies to prevent the development of disease may be implemented. The treatment of latent tuberculosis infection is well described in many national guidelines. In this review, we attempt to help pneumonologists to implement these guidelines accurately and appropriately, prescribing preventive treatment when the benefit-risk ratio is optimal, providing treatment most safely, performing therapeutic education and incorporating preventive treatment into the full array of measures against tuberculosis.

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Renal transplantationComplication: InfectionMycobacterium tuberculosis Infection in Renal Transplant Recipients

Abstract

Section snippets

Patients and methods

Results

Discussion

Transplant Proc

Transplant Proc

Clin Chest Med

Transplant Proc

Kidney Int

Renal transplantation
Complication: Infection
Mycobacterium tuberculosis Infection in Renal Transplant Recipients