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Clinical characteristics, risk factors, and outcome of tuberculosis in kidney transplant recipients: A multicentric case‐control study in a low‐endemic area
Author(s) -
Gras Julien,
De Castro Nathalie,
Montlahuc Claire,
Champion Laure,
Scemla Anne,
Matig Marie,
Lachâtre Marie,
Raskine Laurent,
Grall Nathalie,
Peraldi Marie Noëlle,
Molina Jean Michel
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12943
Subject(s) - medicine , tuberculosis , transplantation , univariate analysis , kidney transplantation , retrospective cohort study , pediatrics , multivariate analysis , surgery , pathology
Objectives Tuberculosis ( TB ) is a rare but life‐threatening infection after solid organ transplant. The present study was undertaken to assess the clinical features, risk factors, and outcome of TB after kidney transplantation in a low‐prevalence area. Methods We conducted a retrospective study, describing all kidney transplant recipients diagnosed with TB between 2005 and 2015 in 3 French centers. For each TB case, 2 controls without TB were identified and matched by center, age, transplant date, and birth country. Risk factors associated with TB were identified and survival estimated. Results Thirty‐two cases and 64 control patients were included among 3974 transplantations. The prevalence of TB was 0.83%. Median age at the time of diagnosis was 64 years; 75% were born in a high TB prevalence country, but only 3 had received isoniazid prophylaxis for latent TB infection. TB occurred at a median of 22 months after transplantation. On diagnosis, 66% had disseminated infection. Median duration of treatment was 9 months. Immunosuppressive therapy changes were necessary in all patients because of drug‐drug interactions. Among cases, 5 deaths occurred during follow‐up (median duration: 41 months), one directly related with TB . Survival was significantly lower in transplant recipients with TB , as compared to controls ( P = .001). No predictive factors of tuberculosis after transplantation were statistically significant in univariate analysis. Conclusion TB in kidney transplant recipients is a rare and late event, but is associated with significantly reduced survival. Our results emphasize the need for systematic screening for LTBI , followed by IPT in high‐risk patients.