Abdominal tuberculosis following kidney transplantation: clinicopathologic features and follow-up in a unique case series.
BACKGROUND
Kidney transplant recipients are at a high risk of opportunistic infection. The aims of this study were to describe the epidemiology, clinical features, and prognosis of abdominal tuberculosis (TB) in kidney transplant recipients.


METHODS
All cases of abdominal TB that occurred in kidney transplant recipients at our center between 1998 and 2010 were retrospectively reviewed. Detailed demographic data, clinical profile information, and the treatment response were recorded.


RESULTS
Among the 7833 kidney transplantations performed during the study period, eight patients (0.1%) developed abdominal TB. There were four men and four women in this group. The mean age of the patients was 44 ± 12 yr. The time from kidney transplantation to TB was 6.7 ± 3.4 yr. The symptoms were weight loss (87.5%), diarrhea (87.5%), fever (75%), abdominal pain (62.5%), and lower gastrointestinal bleeding (37.5%). The delay between the identification of the clinical symptoms and the diagnosis was an average of six months. The diagnosis was confirmed histopathologically for most patients. The cecum and ascending colon were the most common sites involved. Two patients required surgical intervention. Five patients received a 4-drug regimen, and three had hepatotoxicity. The median length of antituberculous therapy was nine (6-12) months. Five patients lost their graft. Overall, the hospital mortality was 12.5%.


CONCLUSIONS
Kidney transplantation increases the risk of TB, particularly as an extrapulmonary disease. The symptoms of infection are often attenuated, leading to delayed diagnosis. Therefore, a careful approach to the patient and supportive data are necessary to make the final and timely diagnosis.
Department of Nephrology, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
Ana
A
Rocha
Laercio
L
Lourenço
Laila
L
Viana
Marcus
M
Taver
Melissa
M
Gaspar
Jose Osmar
JO
Medina-Pestana
D015746:Abdominal Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D055815:Young Adult
D000995:Antitubercular Agents
abdominal; diagnosis; kidney transplantation; prognosis; tuberculosis