Premium
Clinical features and outcomes of tuberculosis in kidney transplant recipients in B razil: a report of the last decade
Author(s) -
Marques Igor D. B.,
Azevedo Luiz S.,
Pierrotti Lígia C.,
Caires Renato A.,
Sato Víctor A. H.,
Carmo Lilian P. F.,
Ferreira Gustavo F.,
Gamba Cristiano,
Paula Flávio J.,
Nahas William C.,
DavidNeto Elias
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12077
Subject(s) - medicine , tuberculosis , incidence (geometry) , kidney transplantation , transplantation , retrospective cohort study , surgery , history of tuberculosis , population , pediatrics , pathology , physics , environmental health , optics
Background Among kidney transplant recipients ( KTR s), tuberculosis is one of the most common opportunistic infections and is associated with high morbidity and mortality. The aim of this study was to describe the incidence, clinical features, and prognosis of tuberculosis in KTR s. Methods Retrospective single‐center observational study involving all cases of tuberculosis in KTR s between 2000 and 2010. Results Of the 1549 KTR s evaluated, 43 (2.8%) developed tuberculosis, translating to an annual incidence of 803 cases/100 000 patients, considerably higher than that reported for the general population of B razil. The median time to tuberculosis ( TB ) onset after transplantation was 196 d (range, 19–3626 d). Of the KTR s with tuberculosis, 67% became infected within the first year post‐transplant, 74% had pulmonary tuberculosis, and 7% had a previous history of active tuberculosis. No tuberculosis prophylaxis was employed before or after transplantation. The most common symptoms were fever (in 79%), cough (in 35%), and dyspnea (in 16%). The median time from the onset of symptoms to the start of treatment was 28 d. The median duration of antituberculosis therapy was 196 d. In 15 patients (35%), the immunosuppressive therapy was reduced, and the incidence of acute rejection was higher in patients with tuberculosis than in those without (44% vs. 28%). Mortality during tuberculosis treatment was 12% (5 cases), and all five deaths were attributed to tuberculosis. Ten‐yr death‐censored graft survival and patient survival were similar between patients with tuberculosis and those without. Conclusion Among KTR s, symptoms of tuberculosis are often attenuated, which leads to delayed diagnosis, and tuberculosis‐related mortality remains high.