Tuberculosis in Egyptian kidney transplant recipients: study of clinical course and outcome.
BACKGROUND
Tuberculosis (TB) is an important infection encountered post-transplantation especially in developing countries, with high incidences of morbidity and mortality. In this report, we study the risk factors and impact of TB on the outcome of kidney transplantation.


METHODS
Of 1200 live-donor Egyptian kidney transplantations, 45 (3.8%) patients developed post-transplant TB. Of these, five had had TB pre-transplantation and 40 were male. The mean age was 32.6 +/- 10.5 years. Primary immunosuppression treatment for 39 (86.7%) patients was cyclosporine (CsA).


RESULTS
The mean time interval between transplantation and TB diagnosis was 49.8 +/- 41.5 (range 2-180) months. In 86.7% of patients, TB was diagnosed one year post-transplantation. Urinary TB was the most common form (53%), while pleuropulmonary TB accounted for 38%. All post-transplant TB patients received a triple anti-tuberculous therapy (rifampicin, ethambutol and INH) with a favorable response in all but two patients who needed another 24-month course. Hepatotoxicity was seen in 11 patients, eight were mild with normalization after temporary withdrawal of rifampicin, and three cases were severe, but mortality was not attributable to hepatocellular failure. Twelve patients died, 11 of them due to unrelated causes. Chronic rejection occurred in more than half of the patients (55.6%), of whom 24 (96%) were CsA-treated, which can be attributed to rifampicin/CsA interaction. More than 35% of TB patients lost their graft as a result. Pre-transplant tuberculosis patients had a comparable post-transplant course.


CONCLUSIONS
TB is a common infection in renal transplant recipients with a peak incidence occurring one year post-transplant. Chronic rejection is a serious complication that had a negative impact on the graft survival, especially in CsA-treated recipients. INH prophylaxis is safe in pre-transplant TB. The post-transplantation outcome in the pre-transplant tuberculosis patients is no different from non-TB patients.
el-Agroudy
Amgad E
AE
Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt. amgadelbaz@ahram0505.net
Refaie
Ayman F
AF
Moussa
Omar M
OM
Ghoneim
Mohamed A
MA
D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury; D002908:Chronic Disease; D016572:Cyclosporine / Q000009:adverse effects; D004347:Drug Interactions; D004534:Egypt; D005260:Female; D006084:Graft Rejection / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008107:Liver Diseases / Q000503:physiopathology; D008297:Male; D012293:Rifampin / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology; D014401:Tuberculosis, Urogenital / Q000453:epidemiology
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D012293:Rifampin