title: Impact of type of calcineurin inhibitor on post-transplant tuberculosis: Single-center study from India.
abstract: BACKGROUND
  Tuberculosis (TB) is an important cause of morbidity and mortality in renal transplant recipients. Immunosuppressive drugs are one of the most important risk factor for post-transplant tuberculosis (PTTB). A paucity of data exists about the impact of the type of calcineurin inhibitor on PTTB.
  
  
  METHODS
  In this retrospective study, all adult patients on calcineurin inhibitor-based immunosuppression were included. Patients receiving TB chemoprophylaxis were excluded. Diabetes, duration of dialysis, hepatitis B and C, past treated TB, induction therapy, type of antimetabolite, acute rejection, new onset of diabetes after renal transplantation (RT) (NODAT) and cytomegalovirus (CMV) were analyzed in tacrolimus (Tac) and cyclosporine (CsA) groups. Primary outcome was incidence of TB and secondary outcomes were timeline of development of TB after RT and pattern of TB in the two groups.
  
  
  RESULTS
  Of the 1664 patients included, 582 patients received CsA-based immunosuppression while 1082 received Tac-based immunosuppression. Duration of dialysis, positive tuberculin skin test, use of induction, mycophenolate mofetil use, CMV infection, and NODAT were significantly more, and hepatitis B infection, past treated TB, and acute rejection episodes were significantly less in the Tac group. At the end of follow-up, incidence of TB in the Tac group was significantly less than in the CsA group (6.1% vs 19.9%, P<.001). Mean time for development of TB after RT was similar in both the groups and nodal and disseminated TB were more common in the Tac group.
  
  
  CONCLUSIONS
  In conclusion, our study shows that use of Tac as compared to CsA significantly decreases incidence of PTTB. Time of infection since transplant was similar in both the groups. However, nodal and disseminated TB were more common in the Tac group.
authors: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors: Sanjay K
authors: SK
authors: Agarwal
authors: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors: Dipankar
authors: D
authors: Bhowmik
authors: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors: Sandeep
authors: S
authors: Mahajan
authors: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors: Soumita
authors: S
authors: Bagchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D007194:India / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: India; renal transplant; tacrolimus; tuberculosis