American Journal of Medical Sciences and Medicine. 2013, 1(5), 75-82DOI:
Abstract: Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. Post-transplant TB is a problem in successful long-term outcome of renal transplantation recipients. It is a life-threatening opportunistic infection that is frequently encountered, but the diagnosis is often delayed. With the emergence of newer potent immunosuppressive regimens and an increased incidence of TB in the general population, post-transplant TB among transplant recipients can be anticipated. Our objective was to describe the pattern and risk factors of TB infection, and the prognosis in our transplant recipients. This study was a retrospective review of the records of 491 renal transplant recipients in our hospital during the period from January 1986 to December 2009. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. 16 patients (3.2%) developed posttransplant TB with a mean age of 32.5 ± 12.7 (range: 13-60) years and a mean post-transplant period of 36,6 months (range: 12,3 months – 15.9 years). The forms of the diseases were pulmonary in 10 /16 (62.6%), disseminated in 3/16 (18.7%) and extrapulmonary in 3/16 (18.7%). All patients initially received 4-drug combination therapy. Because of drug interaction, an increase in the dose of calcineurium inhibitor and steroid was done in 2 cases and in steroids alones in 1 case. Graft dysfunction was observed in 7 cases (43,7%) with tissue-proof acute rejection in 3 cases and loss of the graft in 4 cases. Hepatotoxicity developed in 3 patients (18.7%) during treatment. Reccurence were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Extrapulmonary and disseminated tuberculosis were observed in third of our patients. More than 9 months of treatment may be necessary to prevent recurrence.