Characteristics of post-operational tuberculosis in renal transplant recipients and experiences in diagnosis and treatment

Abstract

Objective To investigate the characteristics of post-operational tuberculosis in renal transplant recipients and related experiences in diagnosis and management. Methods 2333 cases of re-nal transplantation in our center between Jan. 1991 and Apr. 2007 were retrospectively studied, and the 37 cases with definite diagnosis of post-operational tuberculosis were analyzed. The characteristics of the disease and experiences in diagnosis and management were summarized. Results The incidence of post-operational tuberculosis in renal transplant recipients was 1.59%. The median time of onset was 7 months post-transplant (1～91 months), with 22 cases suffering from tuberculosis within 1 year. Twenty-nine cases had pulmonary tuberculosis with or without extra-pulmonary loci, and 8 ca-ses had only extra-pulmonary foci. Fever, cough and expectoration were main clinical manifestations. Results of purified protein derivative of tuberculin skin test were all negative. Characteristic features were identified in chest films of 29 patients. Acid-fast bacilli were found in sputum smears from 6 pa-tients, and 16 other cases also got pathogenic or pathologic diagnosis. Seven patients were diagnosed having co-infections. First-line anti-tuberculosis drugs were used when immunosuppressants were ceased or modified. Twenty-eight patients recovered while 9 died. Conclusions Renal transplant re-cipients face a high risk of post-operational tuberculosis. Monitoring the serum concentration of immu-nosuppressant(s), personalizing anti-tuberculosis and immunosuppressive therapies are important. Key words: Kidney transplantation; Tuberculosis; Diagnosis; Therapy