Journal Article

Tuberculosis following kidney transplantation: clinical features and outcome. A French multicentre experience in the last 20 years

Emmanuel Canet, Jacques Dantal, Gilles Blancho, Maryvonne Hourmant and Stéphanie Coupel

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 11, pages 3773-3778
Published in print November 2011 | ISSN: 0931-0509
Published online April 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr156
Tuberculosis following kidney transplantation: clinical features and outcome. A French multicentre experience in the last 20 years

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Background. Kidney transplant recipients are at high risk of opportunistic infection. The aims of this study were to describe the epidemiology, clinical features and prognosis of Tuberculosis (TB) in kidney transplant recipients.

Methods. Retrospective observational study conducted in 14 French transplant centres involving all cases of TB that occurred in kidney transplant recipients between 1986 and 2006.

Results. Among the 16146 kidney transplantations performed during the study period, 74 (0.45%) developed TB. The country of birth was a highly endemic area for TB in 20 (40.8%) patients. Time from kidney transplantation to TB was 10 months (4–27). Extrapulmonary and disseminated TB accounted for 33 (67.4%) cases. The most common symptoms were fever (71.7%), weight loss (41.3%) and asthenia (39.1%). Coexisting infections were diagnosed in 11 (22.4%) patients. Microbial sensitivity tests revealed no case of multidrug-resistant TB. Haemophagocytic syndrome associated with TB was diagnosed in 5 (10.2%) cases with 60% of mortality (P = 0.0005). Median length of antituberculous therapy was 12 (9.5–12) months. Immunosuppressive therapy was reduced in 22 (44.9%) patients without adverse consequence on the graft. Overall, hospital mortality was 6.1% and 1-year graft survival was 97%.

Conclusions. Kidney transplantation increases the risk of TB, with a high rate of extrapulmonary disease. Symptoms of infection are often attenuated, leading to delayed diagnosis. Overall prognosis is good but haemophagocytic syndrome is associated with high mortality. Country of birth might be taken into account in the decision of post-transplantation treatment of latent TB.

Keywords: infection; kidney transplantation; tuberculosis; haemophagocytic syndrome

Journal Article.  3569 words.  Illustrated.

Subjects: Nephrology

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