Tuberculosis in renal transplant patients: the experience of a single center in Medellín-Colombia, 2005-2013

J Bras Nefrol. 2014 Oct-Dec;36(4):512-8. doi: 10.5935/0101-2800.20140073.
[Article in English, Portuguese]

Abstract

Introduction: Tuberculosis is a common opportunistic infection in renal transplant patients.

Objective: To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital.

Methods: Retrospective and descriptive study.

Results: In 641 renal transplants, tuberculosis was confirmed in 12 cases. Of these, 25% had a history of acute rejection, and 50% had creatinine levels greater than 1.5 mg/dl prior to infection. The disease typically presented as pulmonary (50%) and disseminated (33.3%). The first phase of treatment consisted of 3 months of HZRE (isoniazid, pyrazinamide, rifampicin and ethambutol) in 75% of the cases and HZME (isoniazid, pyrazinamide, moxifloxacin and ethambutol) in 25% of the cases. During the second phase of the treatment, 75% of the cases received isoniazid and rifampicin, and 25% of the cases received isoniazid and ethambutol. The length of treatment varied between 6 and 18 months. In 41.7% of patients, hepatotoxicity was associated with the beginning of anti-tuberculosis therapy. During a year-long follow-up, renal function remained stable, and the mortality rate was 16.7%.

Conclusion: Tuberculosis in the renal transplant population studied caused diverse nonspecific symptoms. Pulmonary and disseminated tuberculosis were the most frequent forms and required prolonged treatment. Antituberculosis medications had a high toxicity and mortality. This infection must be considered when patients present with a febrile syndrome of unknown origin, especially during the first year after renal transplant.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Colombia
  • Female
  • Humans
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / drug therapy
  • Retrospective Studies
  • Time Factors
  • Tuberculosis / diagnosis*
  • Tuberculosis / drug therapy
  • Young Adult