#833 Spectrum of tuberculosis after kidney transplantation: a case-control study in a middle-endemic area

Abstract

Abstract Background and Aims Tuberculosis (TB) is the leading cause of infectious-disease death worldwide. Post-transplant TB is a problem in successful long-term outcome of kidney transplantation recipients (KT) and is often associated with high morbidity and mortality. The aim of this study was to assess the clinical features, risk factors, and outcome of TB after kidney transplantation in a middle-prevalence area. Method We performed a retrospective analysis of a cohort of adult KT recipients from 2015 to 2020 at the Annaba University Hospital with follow-up until October 2022. Results Among 152 KT recipients evaluated, 8 developed TB, the prevalence was 5.26%. Median time to diagnosis was 28.4 months, with 25% of the cases occurring in the first Two year. Pulmonary TB represented 75% of the cases, including disseminated disease. Two patients received isoniazid prophylaxis for latent TB infection and developed active infection. Median duration of treatment was 12 months. However TB was associated with a significant reduction in patient and graft survival (74% vs. 90.2% in 5 years for patient survival, P=0.001; and 58.6% vs. 80.2% in 5 years for graft survival, P<0.001). Death and graft loss occurred in the first 6 months after diagnosis in one-third of the patients, 38.8% of them with disseminated disease. Disseminated disease was significantly associated with mortality compared to local disease (41.8% vs. 9.7%, P=0.035). It should also be pointed out that Algeria is a country with an intermediate level of tuberculosis endemicity. Conclusion TB is the archetype of opportunistic infection in KT, with significant impact on patient and graft survival. Our results emphasize the need for systematic screening for LTBI in all patients awaiting transplant. Treatment challenges in KT recipients with TB, drug interactions, drug toxicities and therapeutical adherence must be considered.