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Sorohan BM, Ismail G, Tacu D, Obrișcă B, Ciolan G, Gîngu C, Sinescu I, Baston C. Mycobacterium Tuberculosis Infection after Kidney Transplantation: A Comprehensive Review. Pathogens 2022; 11:pathogens11091041. [PMID: 36145473 PMCID: PMC9505385 DOI: 10.3390/pathogens11091041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) in kidney transplant (KT) recipients is an important opportunistic infection with higher incidence and prevalence than in the general population and is associated with important morbidity and mortality. We performed an extensive literature review of articles published between 1 January 2000 and 15 June 2022 to provide an evidence-based review of epidemiology, pathogenesis, diagnosis, treatment and outcomes of TB in KT recipients. We included all studies which reported epidemiological and/or outcome data regarding active TB in KT, and we approached the diagnostic and treatment challenges according to the current guidelines. Prevalence of active TB in KT recipients ranges between 0.3–15.2%. KT recipients with active TB could have a rejection rate up to 55.6%, a rate of graft loss that varies from 2.2% to 66.6% and a mortality rate up to 60%. Understanding the epidemiological risk, risk factors, transmission modalities, diagnosis and treatment challenges is critical for clinicians in providing an appropriate management for KT with TB. Among diagnostic challenges, which are at the same time associated with delay in management, the following should be considered: atypical clinical presentation, association with co-infections, decreased predictive values of screening tests, diverse radiological aspects and particular diagnostic methods. Regarding treatment challenges in KT recipients with TB, drug interactions, drug toxicities and therapeutical adherence must be considered.
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Affiliation(s)
- Bogdan Marian Sorohan
- Department of Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Department of General Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
- Correspondence: ; Tel.: +40-740156198
| | - Gener Ismail
- Department of General Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Dorina Tacu
- Department of Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Bogdan Obrișcă
- Department of General Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gina Ciolan
- Department of Pneumology, Marius Nasta National Institute of Pneumology, 050159 Bucharest, Romania
| | - Costin Gîngu
- Department of Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Department of General Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
| | - Ioanel Sinescu
- Department of Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Department of General Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
| | - Cătălin Baston
- Department of Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Department of General Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania
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Alemu A, Bitew ZW, Diriba G, Seid G, Eshetu K, Chekol MT, Berhe N, Gumi B. Tuberculosis incidence in patients with chronic kidney disease: a systematic review and meta-analysis. Int J Infect Dis 2022; 122:188-201. [PMID: 35609860 DOI: 10.1016/j.ijid.2022.05.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study was to estimate global TB incidence in patients with CKD. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was followed to perform the study. Electronic and gray literature sources were investigated for studies published between 2000 and 2021. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the studies, and STATA version 16 was used for analysis. The I2 heterogeneity test was employed to assess heterogeneity. To examine publication bias, funnel plots and Egger's regression tests were performed. RESULTS A total of 104 studies with a sample size of 1,548,774 were included. TB incidence in patients with CKD ranges from 60 per 100,000 in the UK to 19,270 per 100,000 in China. The pooled TB incidence was estimated as 3718 per 100,000 (95%CI; 3024, 4411). Higher pooled TB incidence was found in the African region (9952/100,000, 95%CI; 6854, 13,051), followed by the South-East Asian (7200/100,000, 95%CI; 4537, 9863) and Eastern Mediterranean (5508/100,000, 95%CI; 3470, 7547) regions. In particular, patients on hemodialysis (5611/100,000) and on peritoneal dialysis (3533/100,000) had higher incidence of TB than did renal transplantation patients (2700/100,000) and patients with predialysis CKD (913/100,000). Furthermore, extrapulmonary TB (2227/100,000) was more common than pulmonary TB (1786/100,000). CONCLUSION This study identifies high TB incidence in patients with CKD with regional disparities. Thus, the authors recommend active TB screening in this group of individuals.
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Nasir N, Sarfaraz S, Khanum I, Ansari T, Nasim A, Dodani SK, Luxmi S. Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00756-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sahay M, Kunthara M, Hussain H, Ismal K, Vali PS, Kavadi A, Kumar BV. Posttransplant renal allograft dysfunction – A retrospective observational study. Indian J Transplant 2021. [DOI: 10.4103/ijot.ijot_129_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Igari H, Akutsu N, Ishikawa S, Aoyama H, Otsuki K, Hasegawa M, Maruyama M, Tsuyuzaki M, Suzuki K, Saigo K. Positivity rate of interferon-γ release assays for estimating the prevalence of latent tuberculosis infection in renal transplant recipients in Japan. J Infect Chemother 2019; 25:537-542. [PMID: 30905632 DOI: 10.1016/j.jiac.2019.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/28/2019] [Accepted: 02/23/2019] [Indexed: 02/04/2023]
Abstract
Renal transplant recipients are at increased risk of reactivating latent tuberculosis infection (LTBI) and developing active tuberculosis. QuantiFERON®-TB Gold Plus (QFT-Plus) has two TB-specific antigens tubes (TB1 and TB2). TB1 elicits CD4 T-cell response, and TB2 elicits both CD4 and CD8 T-cells responses, with expected increased sensitivity. The aim of this study was to estimate the prevalence of LTBI in renal transplant recipients in Japan. We conducted a cross-sectional study by using two interferon-γ release assays (IGRAs), QFT-Plus and T-SPOT®.TB (TSPOT). One hundred thirty-five recipients were prospectively enrolled. The median age was 49 years (range: 20 to 79). The positivity rates of QFT-Plus and TSPOT were 5.9% (95%CI 3.0-11.3) and 3.7% (95%CI 1.6-8.4), respectively, with no significant difference. The concordance rate was 95.5% (κ coefficient, 0.76). Age of 60 years and higher was related to the higher positivity rate in both QFT-Plus and TSPOT. The positivity rates of TB1 and TB2 were 5.1% (95%CI 2.5-10.2) and 5.9% (95%CI 3.0-11.2), respectively, with no significant difference. The concordance rate was 99.3% (κ coefficient, 0.93). TB2 did not show a higher positivity rate compared with TB1. The estimated prevalence of LTBI by using the both IGRAs was 3.7-5.9% in renal transplant recipients. These results were equivalent to the IGRAs positivity rate in the general Japanese population, even under the condition of immunosuppressive therapy. In consideration of the higher risk of developing active TB from LTBI, we can use both IGRAs as acceptable tools for LTBI diagnosis in renal transplant recipients.
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Affiliation(s)
- Hidetoshi Igari
- Division of Infection Control, Chiba University Hospital, Chiba, Japan.
| | - Naotake Akutsu
- Department of Surgery, National Hospital Organization Chiba-East Hospital, 673 Nitona-cho Chuo-ku, Chiba, 260-8712, Japan.
| | - Satoru Ishikawa
- Department of Respiratory Medicine, National Hospital Organization Chiba-East Hospital, 673 Nitona-cho Chuo-ku, Chiba, 260-8712, Japan.
| | - Hiromichi Aoyama
- Department of Surgery, National Hospital Organization Chiba-East Hospital, 673 Nitona-cho Chuo-ku, Chiba, 260-8712, Japan.
| | - Kazunori Otsuki
- Department of Surgery, National Hospital Organization Chiba-East Hospital, 673 Nitona-cho Chuo-ku, Chiba, 260-8712, Japan.
| | - Masayuki Hasegawa
- Department of Surgery, National Hospital Organization Chiba-East Hospital, 673 Nitona-cho Chuo-ku, Chiba, 260-8712, Japan.
| | - Michihiro Maruyama
- Department of Surgery, National Hospital Organization Chiba-East Hospital, 673 Nitona-cho Chuo-ku, Chiba, 260-8712, Japan.
| | - Mizue Tsuyuzaki
- Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato Mihama-ku, Chiba, 261-0002, Japan.
| | - Kiminori Suzuki
- Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato Mihama-ku, Chiba, 261-0002, Japan.
| | - Kenichi Saigo
- Department of Surgery, National Hospital Organization Chiba-East Hospital, 673 Nitona-cho Chuo-ku, Chiba, 260-8712, Japan.
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Pattanashetti N, Gupta S, Rana S, Dahiya D, Das A, Kumar V, Rathi M, Kohli HS, Gupta KL, Ramachandran R. Intestinal Tuberculosis: A Rare Case of Massive Gastrointestinal Bleed in a Post-Renal Transplant Recipient. Indian J Nephrol 2019; 29:132-134. [PMID: 30983756 PMCID: PMC6440334 DOI: 10.4103/ijn.ijn_360_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Massive rectal bleeding is an uncommon presentation of ileal tuberculosis (TB). We report an uncommon cause of anemia in a post-renal transplant patient due to massive lower gastrointestinal (LGI) bleed. The index case had a normal upper and LGI endoscopy, but the 99technetium labeled red blood cell scan showed active bleeding from terminal ileum and caecum. Microscopic examination of the resected specimen revealed tubercular granuloma with acid-fast bacilli. Intestinal TB should be a differential diagnosis for massive LGI bleed in immunosuppressed patients in developing country.
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Affiliation(s)
| | - S Gupta
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - S Rana
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - D Dahiya
- Department of General Surgery, PGIMER, Chandigarh, India
| | - A Das
- Department of Histopathology, PGIMER, Chandigarh, India
| | - V Kumar
- Department of Nephrology, PGIMER, Chandigarh, India
| | - M Rathi
- Department of Nephrology, PGIMER, Chandigarh, India
| | - H S Kohli
- Department of Nephrology, PGIMER, Chandigarh, India
| | - K L Gupta
- Department of Nephrology, PGIMER, Chandigarh, India
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Abstract
Mycobacterium tuberculosis is a major opportunistic pathogen in transplant recipients. Compared to that in the general population, the frequency of tuberculosis (TB) is 10 to 40 times higher in hematopoietic stem cell transplant (HSCT) recipients and 20 to 74 times higher in solid-organ transplant (SOT) recipients. Transplant recipients with TB are also more likely to develop disseminated disease, have longer time to definitive diagnosis, require more invasive diagnostic procedures, and experience greater anti-TB treatment-related toxicity than the general population. Specific risk factors for TB in SOT recipients include previous exposure to M. tuberculosis (positive tuberculin skin tests and/or residual TB lesions in pretransplant chest X ray) and the intensity of immunosuppression (use of antilymphocyte antibodies, type of basal immunosuppression, and intensification of immunosuppressive therapy for allograft rejection). Risk factors in HSCT recipients are allogeneic transplantation from an unrelated donor; chronic graft-versus-host disease treated with corticosteroids; unrelated or mismatched allograft; pretransplant conditioning using total body irradiation, busulfan, or cyclophosphamide; and type and stage of primary hematological disorder. Transplant recipients with evidence of prior exposure to M. tuberculosis should receive treatment appropriate for latent TB infection. Optimal management of active TB disease is particularly challenging due to significant drug interactions between the anti-TB agents and the immunosuppressive therapy. In this chapter, we address the epidemiology, clinical presentation, diagnostic considerations, and management strategies for TB in SOT and HSCT recipients.
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Agarwal SK, Bhowmik D, Mahajan S, Bagchi S. Impact of type of calcineurin inhibitor on post-transplant tuberculosis: Single-center study from India. Transpl Infect Dis 2016; 19. [DOI: 10.1111/tid.12626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/24/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Sanjay K. Agarwal
- Department of Nephrology; All India Institute of Medical Sciences; New Delhi India
| | - Dipankar Bhowmik
- Department of Nephrology; All India Institute of Medical Sciences; New Delhi India
| | - Sandeep Mahajan
- Department of Nephrology; All India Institute of Medical Sciences; New Delhi India
| | - Soumita Bagchi
- Department of Nephrology; All India Institute of Medical Sciences; New Delhi India
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Abstract
Background: Infectious disorders are a major cause of concern in renal transplant recipients (RTRs) leading to considerable morbidity and mortality. We studied the profile and outcomes of infectious disorders in a cohort of RTR. Materials and Methods: In this prospective, observational study, we evaluated all RTR who presented with the features of infection. We also included asymptomatic patients with microbiological evidence of infection. We excluded patients with acute rejection, drug toxicity, and malignancy. Descriptive statistics were used to analyze the results. Results: The study population (n = 45, 35 male and 10 female) had a mean age of 35.5 ± 10.4 years and follow-up after transplant was 2.1 ± 1.7 years. Urinary tract infection (UTI, n = 15) is the most common infection followed by tuberculosis (TB, n = 8), cytomegalovirus (n = 6), candidiasis (n = 7), and hepatitis (n = 11). Miscellaneous infections such as cryptosporidiosis and pneumocystis were seen in 10 patients. Simultaneous infections with two organisms were seen in 7 patients. Four patients succumbed to multiorgan dysfunction following sepsis, another 4 patients developed chronic graft dysfunction, while the remaining 35 RTR had a good graft function. Conclusion: Infectious complications are very common in the posttransplant period including UTI and TB. Further large scale studies are required to identify the potential risk factors leading to infections in RTR.
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Affiliation(s)
- Arun Kumar
- Department of Nephrology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Chaturbhuj Agarwal
- Department of Nephrology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Ashok K Hooda
- Department of Nephrology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Ashutosh Ojha
- Department of Medicine, AFMC, Pune, Maharashtra, India
| | - Mukesh Dhillon
- Department of Medicine, Military Hospital, Ambala, India
| | - K V S Hari Kumar
- Department of Endocrinology, Army Hospital (R and R), Delhi, India
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Pereira M, Gazzoni FF, Marchiori E, Irion K, Moreira J, Giacomelli IL, Pasqualotto A, Hochhegger B. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol 2015; 89:20150686. [PMID: 26607644 DOI: 10.1259/bjr.20150686] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Renal transplantation recipients are at increased risk of Mycobacterium tuberculosis infection because of immunosuppression. The aim of this study was to assess high-resolution CT (HRCT) findings in renal transplantation recipients diagnosed with pulmonary tuberculosis (TB). METHODS We reviewed HRCT findings from patients diagnosed with pulmonary TB, established by M. tuberculosis detection in bronchoalveolar lavage, sputum or biopsy sample. Two observers independently reviewed HRCT images and reached consensus decisions on the presence and distribution of: (i) miliary nodules, (ii) cavitation and centrilobular tree-in-bud nodules, (iii) ground-glass attenuation and consolidation, (iv) mediastinal lymph node enlargement and (v) pleural effusion. RESULTS The sample comprised 40 patients [26 males, 14 females; median age, 45 years (range, 12-69 years)]. The main HRCT pattern was miliary nodules (40%), followed by cavitation and centrilobular tree-in-bud nodules (22.5%), ground-glass attenuation and consolidation (15%), mediastinal lymph node enlargement (12.5%) and pleural effusion (10%). The distribution of findings in patients with miliary nodules was random. In patients with cavitation and centrilobular tree-in-bud nodules, 66.6% of abnormalities were found in the upper lobes. Pleural effusion was unilateral in 75% of cases. The overall mortality rate was 27.5%. This rate was 50% in patients with miliary nodules, and 72.6% of all deaths occurred in this group. Thus, mortality was increased significantly in patients with miliary nodules (p < 0.05). CONCLUSION The main HRCT finding in renal transplantation recipients with pulmonary TB was miliary nodules, followed by cavitation and centrilobular tree-in-bud nodules. Miliary nodules were associated with a worse prognosis in these patients. ADVANCES IN KNOWLEDGE We report the first series on HRCT findings of microbiologically confirmed pulmonary TB exclusively in renal transplantation recipients. The main HRCT finding was miliary nodules, and mortality was increased significantly in these patients.
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Affiliation(s)
- Marisa Pereira
- 1 Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernando F Gazzoni
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Edson Marchiori
- 3 Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Klaus Irion
- 4 Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Jose Moreira
- 1 Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Irai L Giacomelli
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Alessandro Pasqualotto
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Bruno Hochhegger
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
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Abstract
Tropical infectious diseases (IDs) remain a rare complication in transplant recipients even in tropical settings, but this topic has become increasingly important during the last decade due to multiple factors. Interestingly, non-tropical countries report most of the experiences with tropical diseases. The reported experience from non-endemic regions, however, does not always reflect the experience of endemic areas. Most of the guidelines and recommendations in the literature may not be applicable in tropical settings due to logistical difficulties, cost, and lack of proven benefit. In addition, certain post-transplant prevention measures, as prophylaxis and reducing exposure risk, are not feasible. Nonetheless, risk assessment and post-transplant management of tropical IDs in tropical areas should not be neglected, and clinicians need to have a higher clinical awareness for tropical ID occurring in this population. Herein, we review the more significant tropical ID in transplant patients, focusing on relevant experience reported by tropical settings.
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Affiliation(s)
- Ligia C Pierrotti
- Infectious Diseases Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, 4° andar, São Paulo, 05403-900, SP, Brazil,
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Liu J, Yan J, Wan Q, Ye Q, Huang Y. The risk factors for tuberculosis in liver or kidney transplant recipients. BMC Infect Dis 2014; 14:387. [PMID: 25015108 PMCID: PMC4227141 DOI: 10.1186/1471-2334-14-387] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/03/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Liver or kidney transplant recipients are at a higher risk of developing tuberculosis (TB) than general population. We aimed to clarify the incidence density of and risk factors for TB in liver or kidney transplant recipients in the present study. METHODS All patients with TB following liver or kidney transplantation were investigated retrospectively at the Third Xiangya Hospital, Central South University, Changsha, China. The incidence density of TB was calculated. We performed a nested case-control study (1:1) to investigate by univariate and multivariate logistic regression analysis the potential risk factors for TB. RESULTS From January 2000 to August 2013, 1748 kidney and 166 liver transplant recipients were performed at a university teaching hospital. Among the 1914 recipients, 45 cases (2.4%) of TB were reported. The incidence density was 506 cases per 105 patient-years in kidney or liver transplant recipients, which was 7 times higher than in the general Chinese population (around 70 cases per 105 person-years). The median time to develop TB was 20.0 months (interquartile ratio: 5.0-70.0). The receipt of a graft from a cadaveric donor (odds ratio [OR] = 3.7; 95% confidence interval [CI] = 1.4-10.0; P = 0.010) and the preoperative evidence of latent TB (OR = 6.8; 95% CI = 2.0-22.7; P = 0.002) were identified as two risk factors for developing TB in liver or kidney transplant recipients. CONCLUSIONS The incidence density of TB among liver or kidney transplant recipients was much higher than in the general Chinese population. Recipients receiving a graft from a cadaveric donor and the preoperative evidence of latent TB were two major risk factors for developing TB in liver or kidney transplant recipients.
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Affiliation(s)
| | | | - Qiquan Wan
- Department of Transplant Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Regmi A, Singh P, Harford A. A Case of Multidrug-Resistant Monoarticular Joint Tuberculosis in a Renal Transplant Recipient. Transplant Proc 2014; 46:274-7. [DOI: 10.1016/j.transproceed.2013.07.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 07/24/2013] [Indexed: 02/04/2023]
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Boubaker K, Gargah T, Abderrahim E, Abdallah TB, Kheder A. Mycobacterium tuberculosis infection following kidney transplantation. Biomed Res Int 2013; 2013:347103. [PMID: 24222903 DOI: 10.1155/2013/347103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022]
Abstract
Introduction and Aims. Post-transplant tuberculosis (TB) is a problem in successful long-term outcome of renal transplantation recipients. Our objective was to describe the pattern and risk factors of TB infection and the prognosis in our transplant recipients. Patients and Methods. 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. Results. 16 patients (3,2%) developed post-transplant TB with a mean age of 32,5 ± 12,7 (range: 13–60) years and a mean post-transplant period of 36,6months (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%). 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. Recurrences were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Conclusion. Extra pulmonary and disseminated tuberculosis were observed in third of our patients. More than 9months of treatment may be necessary to prevent recurrence.
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Banasik M, Garcarek J, Lepiesza A, Kurcz J, Kaminska D, Mazanowska O, Boratynska M, Patrzalek D, Klinger M. Successful embolization of the peripheral branches of the superior mesenteric artery performed because of tuberculosis-associated acute bleeding in a patient after a renal transplant. EXP CLIN TRANSPLANT 2013; 11:447-9. [PMID: 23431994 DOI: 10.6002/ect.2012.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a renal transplant recipient infected with Mycobacterium tuberculosis who presented with severe intestinal bleeding. The bleeding was the result of an injured vessel of mesenteric artery distal branches diagnosed by traditional arteriography and computed tomography angiography. As the patient's condition was serious, the only considered rescue therapy was endovascular treatment. The endovascular procedure was successful because the bleeding stopped. Embolization of a small intestinal artery may be a successful rescue treatment of intestinal bleeding in a patient after renal transplant.
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Affiliation(s)
- Miroslaw Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, Poland
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Azevedo P, Freitas C, Silva H, Aguiar P, Farrajota P, Almeida M, Pedroso S, Martins LS, Dias L, Vizcaíno JR, Castro Henriques A, Cabrita A. A case series of gastrointestinal tuberculosis in renal transplant patients. Case Rep Nephrol 2013; 2013:213273. [PMID: 24558621 PMCID: PMC3914201 DOI: 10.1155/2013/213273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/26/2013] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.
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Affiliation(s)
- Pedro Azevedo
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Cristina Freitas
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Hugo Silva
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Pedro Aguiar
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Pedro Farrajota
- Department of Pathology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Manuela Almeida
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Sofia Pedroso
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - La Salete Martins
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Leonídio Dias
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - José Ramón Vizcaíno
- Department of Pathology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - António Castro Henriques
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - António Cabrita
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
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Abstract
Tuberculosis is an opportunistic infection with high morbidity and mortality in solid organ transplant patients. The reasons for this high morbidity and mortality lie mostly in diagnostic difficulties, which cause delays in starting treatment, and associated pharmaceutical toxicity. There are still major issues and difficulties in managing tuberculosis in solid organ transplant patients. These include problems due to interactions between antituberculosis and immunosuppressant drugs, the high risk of toxicity of antituberculosis drugs (particularly in liver transplant patients) and the absence of clear indications for the treatment of latent tuberculous infection. This article updates current understanding of tuberculosis in solid organ transplant patients.
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Affiliation(s)
- Antonio Doblas
- Department of Internal Medicine, Hospital de Alta Resolución Valle del Guadiato, Peñarroya-Pueblonuevo, Córdoba, Spain.
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Ha Y, Joo E, Park S, Wi Y, Kang C, Chung D, Joh J, Lee S, Song J, Peck K. Tacrolimus as a risk factor for tuberculosis and outcome of treatment with rifampicin in solid organ transplant recipients. Transpl Infect Dis 2012; 14:626-34. [DOI: 10.1111/j.1399-3062.2012.00721.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/12/2011] [Accepted: 11/25/2011] [Indexed: 02/06/2023]
Affiliation(s)
- Y.E. Ha
- Division of Infectious Diseases; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - E.J. Joo
- Division of Infectious Diseases; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - S.Y. Park
- Division of Infectious Diseases; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Y.M. Wi
- Division of Infectious Diseases; Samsung Changwon Hospital; Sungkyunkwan University School of Medicine; Changwon; Korea
| | - C.I. Kang
- Division of Infectious Diseases; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - D.R. Chung
- Division of Infectious Diseases; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - J.W. Joh
- Department of Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - S.K. Lee
- Department of Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - J.H. Song
- Division of Infectious Diseases; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - K.R. Peck
- Division of Infectious Diseases; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
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Imai S, Ito Y, Hirai T, Imai H, Ito I, Maekawa K, Chin K, Ichiyama S, Uemoto S, Mishima M. Clinical features and risk factors of tuberculosis in living-donor liver transplant recipients. Transpl Infect Dis 2011; 14:9-16. [DOI: 10.1111/j.1399-3062.2011.00680.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 06/16/2011] [Accepted: 08/04/2011] [Indexed: 12/27/2022]
Affiliation(s)
- S. Imai
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - Y. Ito
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - T. Hirai
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - H. Imai
- Departments of Hepato-Biliary-Pancreatic and Transplant Surgery; Kyoto University; Kyoto; Japan
| | - I. Ito
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - K. Maekawa
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - K. Chin
- Departments of Respiratory Care and Sleep Control Medicine; Kyoto University; Kyoto; Japan
| | - S. Ichiyama
- Department of Clinical Laboratory Medicine; Kyoto University; Kyoto; Japan
| | - S. Uemoto
- Departments of Hepato-Biliary-Pancreatic and Transplant Surgery; Kyoto University; Kyoto; Japan
| | - M. Mishima
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
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Ersan S, Celik A, Atila K, Aykut Sifil A, Cavdar C, Soylu A, Bora S, Gulay H, Camsari T. Tuberculosis in Renal Transplant Recipients. Ren Fail 2011; 33:753-7. [DOI: 10.3109/0886022x.2011.599095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ardalan MR, Shoja MM, Ghabili K. Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report. J Med Case Rep 2011; 5:191. [PMID: 21599877 PMCID: PMC3125360 DOI: 10.1186/1752-1947-5-191] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 05/20/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tuberculosis is still a serious infection among recipients of renal transplants. Although the ileocecal region is the most affected part in intestinal tuberculosis, acute tuberculous appendicitis is quite a rare entity. We report a case of concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant. CASE PRESENTATION A 27-year-old Iranian woman, who had been the recipient of a renal transplant five years earlier, presented with a two-week history of coughing, fever and weight loss. The cause of her end-stage renal disease was chronic pyelonephritis. There were fine crackles noted during a chest examination, and a plain chest radiography showed fine miliary nodules throughout her entire lung fields. Sputum and bronchial aspirate examination was positive for acid-fast bacilli, suggestive of Mycobacterium tuberculosis infection. A chest computed tomography scan revealed widespread miliary nodules, compatible with miliary tuberculosis. She developed severe abdominal pain and abdominal surgery disclosed a perforated appendicitis. Histopathological examination of the resected appendix revealed widespread caseating epithelioid granulomas, suggestive of tuberculosis. CONCLUSION Our case report highlights a rare presentation of tuberculosis in a patient who has undergone renal transplant. Such unusual presentation of tuberculosis, particularly among patients receiving potent immunosuppressive protocols, should be considered by clinicians.
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Affiliation(s)
- Mohammad R Ardalan
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Abstract
BACKGROUND Tuberculosis (TB) remains a leading cause of death in endemic countries and is 20 to 70 times more common in renal transplant recipients, where it contributes to both increased morbidity and mortality. This review will focus on the epidemiology of TB in renal transplant recipients and critically appraise the published literature on isoniazid prophylaxis in renal transplantation. METHODS A literature search for randomized and nonrandomized studies investigating the use of isoniazid prophylaxis in renal transplant recipients was conducted using Ovid MEDLINE, the Cochrane Library, the Transplant Library, and EMBASE. Relative risks (RRs) with 95% confidence intervals (CIs) are reported. Meta-analysis of the randomized controlled trials (RCTs) was performed with a fixed-effects model. RESULTS Eleven relevant studies were identified; six nonrandomized and five RCTs. The nonrandomized studies indicate a reduced risk of TB with isoniazid prophylaxis. The RCTs demonstrated conflicting results, with two studies finding a reduction in TB with prophylaxis and two studies finding no difference. Meta-analysis of the 709 patients from the four RCTs demonstrated a reduced risk of TB with isoniazid prophylaxis (RR, 0.31; 95% CI, 0.19-0.51). No significant difference was found in the incidence of hepatitis (RR, 1.22; 95% CI, 0.91-1.65). CONCLUSION Both randomized and nonrandomized studies support the value of isoniazid as TB prophylaxis in renal transplant recipients at risk of active infection. Clinicians should consider prophylaxis in renal transplant recipients in endemic areas or in recipients in nonendemic countries who are at risk. However, the evidence for the benefit of isoniazid prophylaxis in renal transplantation is not robust and there is still a need for a large multicenter trial of isoniazid prophylaxis in kidney transplantation in an endemic area.
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Holty JE, Sista RR. Mycobacterium tuberculosis infection in transplant recipients: early diagnosis and treatment of resistant tuberculosis. Curr Opin Organ Transplant. 2009;14:613-618. [PMID: 19741533 DOI: 10.1097/mot.0b013e3283324dfc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW To provide a better understanding and summarize recent advances in the diagnosis and treatment of Mycobacterium tuberculosis (MTB) infection in solid organ transplant (SOT) candidates and recipients. RECENT FINDINGS Despite advances in SOT medicine, MTB causes substantial morbidity and mortality in SOT recipients, with reported prevalence rates of 0.4-6%. The primary source of posttransplant MTB is reactivation of pretransplant latent MTB infection. The short-term mortality rate in SOT recipients with drug-susceptible active MTB is 30%. In immunocompromised persons with extensively drug-resistant MTB, the mortality rate approaches 100%. Clinical presentation is often atypical with more than half of SOT recipients presenting with extrapulmonary or disseminated disease. Pretransplant latent MTB infection screening and treatment is the cornerstone for preventing reactivation and dissemination of active MTB posttransplant. Treatment of active MTB in SOT recipients is problematic, given significant drug toxicity and interaction with immunosuppressive agents. SUMMARY A high degree of suspicion for latent and active MTB infection in SOT candidates and recipients is warranted to establish a timely diagnosis and initiate life-saving appropriate therapy.
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Affiliation(s)
- A Subramanian
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Diseases, Baltimore, MD, USA.
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Guida J, Bignotto Rosane D, Urbini-Santos C, Alves-Filho G, Ribeiro Resende M, Mazzali M. Tuberculosis in Renal Transplant Recipients: A Brazilian Center Registry. Transplant Proc 2009; 41:883-4. [DOI: 10.1016/j.transproceed.2009.01.075] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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