Chemoprophylaxis for the prevention of tuberculosis in kidney transplant recipients: A systematic review and meta-analysis

Utilization of kidneys from tuberculosis-infected donors in renal transplantation: A case report

Tuberculosis (TB) infection in solid organ transplantation is a non-negligible problem in TB-endemic countries, and none of the existing guidelines recommend using organs from individuals with active TB infections. Here, we describe three cases of utilization of kidneys from TB-infected donors in renal transplantation at our center, two of whom had active TB. In these three cases, all recipients had good graft function and negative TST results during the 1-4 year follow-up period. This case report emphasizes the critical role of early diagnosis, prophylaxis and treatment of TB in renal transplantation, demonstrates the potential for utilizing kidneys from donors with active TB, and opens up a new possibilities for solid organ transplantation.

Tuberculosis in kidney transplant candidates and recipients

Tuberculosis (TB) is the leading cause of infectious mortality and morbidity in the world, second only to coronavirus disease 2019. Patients with chronic kidney disease and kidney transplant recipients are at a higher risk of developing TB than the general population. Active TB is difficult to diagnose in this population due to close mimics. All transplant candidates should be screened for latent TB infection and given TB prophylaxis. Patients who develop active TB pre- or post-transplantation should receive multidrug combination therapy of antitubercular therapy for the recommended duration with optimal dose modification as per glomerular filtration rate.

HIV and Associated TB: A Lethal Association for Kidney Health?

Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading infectious causes of death globally. The combined brunt of these diseases is experienced mainly in low-income and lower-middle-income countries. HIV/TB have devastating effects on the kidneys, leading to accelerated decline of kidney function as well as mortality. Managing the triad of TB/HIV and kidney disease is challenging. We discuss the epidemiology of HIV/TB coinfection and the kidney and the key mechanisms of kidney disease including genetic susceptibility. The clinical presentation and pathology, as well as the challenges of diagnosing CKD in these patients, also are discussed. The strategies to prevent and manage HIV/TB-related kidney disease such as proper assessment, avoiding nephrotoxic regimens, drug dose adjustments, kidney function monitoring, avoidance of drug-drug interactions, and other interventions are explored. We also briefly discuss the complexities around HIV/TB patients on dialysis and kidney transplantation. HIV/TB coinfection presents an increased risk for kidney-related morbidity and mortality; patients with this triad need to be given special consideration for future research and management.