Clinical features and outcomes of tuberculosis in kidney transplant recipients in Brazil: a report of the last decade.
BACKGROUND
Among kidney transplant recipients (KTRs), tuberculosis is one of the most common opportunistic infections and is associated with high morbidity and mortality. The aim of this study was to describe the incidence, clinical features, and prognosis of tuberculosis in KTRs.


METHODS
Retrospective single-center observational study involving all cases of tuberculosis in KTRs between 2000 and 2010.


RESULTS
Of the 1549 KTRs evaluated, 43 (2.8%) developed tuberculosis, translating to an annual incidence of 803 cases/100 000 patients, considerably higher than that reported for the general population of Brazil. The median time to tuberculosis (TB) onset after transplantation was 196 d (range, 19-3626 d). Of the KTRs with tuberculosis, 67% became infected within the first year post-transplant, 74% had pulmonary tuberculosis, and 7% had a previous history of active tuberculosis. No tuberculosis prophylaxis was employed before or after transplantation. The most common symptoms were fever (in 79%), cough (in 35%), and dyspnea (in 16%). The median time from the onset of symptoms to the start of treatment was 28 d. The median duration of antituberculosis therapy was 196 d. In 15 patients (35%), the immunosuppressive therapy was reduced, and the incidence of acute rejection was higher in patients with tuberculosis than in those without (44% vs. 28%). Mortality during tuberculosis treatment was 12% (5 cases), and all five deaths were attributed to tuberculosis. Ten-yr death-censored graft survival and patient survival were similar between patients with tuberculosis and those without.


CONCLUSIONS
Among KTRs, symptoms of tuberculosis are often attenuated, which leads to delayed diagnosis, and tuberculosis-related mortality remains high.
Renal Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Igor D B
ID
Marques
Luiz S
LS
Azevedo
Lígia C
LC
Pierrotti
Renato A
RA
Caires
Víctor A H
VA
Sato
Lilian P F
LP
Carmo
Gustavo F
GF
Ferreira
Cristiano
C
Gamba
Flávio J
FJ
de Paula
William C
WC
Nahas
Elias
E
David-Neto
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology
D000995:Antitubercular Agents