title: Tuberculosis following kidney transplantation: clinical features and outcome. A French multicentre experience in the last 20 years.
abstract: BACKGROUND
  Kidney transplant recipients are at high risk of opportunistic infection. The aims of this study were to describe the epidemiology, clinical features and prognosis of Tuberculosis (TB) in kidney transplant recipients.
  
  
  METHODS
  Retrospective observational study conducted in 14 French transplant centres involving all cases of TB that occurred in kidney transplant recipients between 1986 and 2006.
  
  
  RESULTS
  Among the 16146 kidney transplantations performed during the study period, 74 (0.45%) developed TB. The country of birth was a highly endemic area for TB in 20 (40.8%) patients. Time from kidney transplantation to TB was 10 months (4-27). Extrapulmonary and disseminated TB accounted for 33 (67.4%) cases. The most common symptoms were fever (71.7%), weight loss (41.3%) and asthenia (39.1%). Coexisting infections were diagnosed in 11 (22.4%) patients. Microbial sensitivity tests revealed no case of multidrug-resistant TB. Haemophagocytic syndrome associated with TB was diagnosed in 5 (10.2%) cases with 60% of mortality (P = 0.0005). Median length of antituberculous therapy was 12 (9.5-12) months. Immunosuppressive therapy was reduced in 22 (44.9%) patients without adverse consequence on the graft. Overall, hospital mortality was 6.1% and 1-year graft survival was 97%.
  
  
  CONCLUSIONS
  Kidney transplantation increases the risk of TB, with a high rate of extrapulmonary disease. Symptoms of infection are often attenuated, leading to delayed diagnosis. Overall prognosis is good but haemophagocytic syndrome is associated with high mortality. Country of birth might be taken into account in the decision of post-transplantation treatment of latent TB.
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris, France. emmanuel.canet@sls.aphp.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.forename: Jacques
authors.initials: J
authors.lastname: Dantal
authors.forename: Gilles
authors.initials: G
authors.lastname: Blancho
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Hourmant
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Coupel
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000254:growth & development*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*