title: Tuberculosis in renal transplant recipients.
abstract: BACKGROUND
  Renal transplant recipients should be considered at high risk for development of Mycobacterium tuberculosis infection (tuberculosis, TB). TB is relatively more frequent among transplant recipients than general population, depending on its epidemicity in the geographic region. Clinical manifestations in this group of patients may be atypical and deserve aggressive investigations for diagnosis. Tuberculin skin test has several limitations regarding diagnosis in chronic renal failure patients. In this retrospective study, we aimed to explore the prevalence and clinical manifestations of TB in renal transplant patients.
  
  
  METHODS
  We retrospectively analyzed the data for TB prevalence, clinical presentations, and patient and graft survivals of total 320 pediatric and adult renal transplant recipients in our center between 1992 and 2010.
  
  
  RESULTS
  The prevalence of TB was 2.8%. Five patients received kidney from living-donor related and four from cadaveric donors. Cadaveric-donor patients received antithymocyte globulin for induction, and four patients received pulse steroid for acute rejection. The median duration of time between transplantation and TB was 21 (1-150) months, and between induction/pulse therapy and infection was 5 (1-100) months. The immunosuppressive protocols included prednisolone and cyclosporine/rapamycin with or without mycophenolate mofetil/azathioprine. The major symptoms were fever (77%), cough (66%), and abdominal pain (22%). Extrapulmonary TB with intestinal (2/9), pericardial (1/9), lymph node (1/9), and cerebral (1/9) involvements developed in five patients. One patient had both pulmonary and testicular involvements. All patients received quartet of anti-TB therapy for a median duration of 9 months. One patient died at the second month of therapy because of dissemination of TB, and one patient returned to hemodialysis because of chronic allograft nephropathy.
  
  
  CONCLUSIONS
  The prevalence of TB was 2.8% in our renal transplant patients. The quartet of anti-TB treatment including rifampicin resulted in success in a majority of patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Dokuz Eylul University Hospital, Izmir, Turkey. sibel.ersan@deu.edu.tr
authors.forename: Sibel
authors.initials: S
authors.lastname: Ersan
authors.forename: Ali
authors.initials: A
authors.lastname: Celik
authors.forename: Koray
authors.initials: K
authors.lastname: Atila
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aykut Sifil
authors.forename: Caner
authors.initials: C
authors.lastname: Cavdar
authors.forename: Alper
authors.initials: A
authors.lastname: Soylu
authors.forename: Seymen
authors.initials: S
authors.lastname: Bora
authors.forename: Huseyin
authors.initials: H
authors.lastname: Gulay
authors.forename: Taner
authors.initials: T
authors.lastname: Camsari
mesh_terms: D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology