Diagnosis and management of extra-pulmonary tuberculosis in renal transplant recipients

Abstract

Objective To analyze the characteristics of extra-pulmonary tuberculosis in renal transplant recipients,and discuss its diagnosis and management. Methods From Jan.1991 to Apr.2007,37 cases of post-operational tuberculosis were identified out of the 2333 renal transplantations done in our center.Among them there were 19 cases with extra-pulmonary foci(51%),which involved allograft kidney in 5 cases,meninges in 4 cases,pleura in 4 cases,lymph node in 3 cases,soft issue in 2 cases,larynx,liver,vertebra and intestine in 1 case each.In 3 cases,there were 2 extrapulmonary sites involved at the same time.Most of the cases happened within one year post-transplant (53%).The most common clinical manifestation was fever. Results After anti-tuberculosis therapy,14 cases were cured and 5 were irresponsible and died.Eight cases (42%) experienced acute rejection and 4 cases(21%)had abnormal liver function during the treatment. Conclusions Extra-pulmonary tuberculosis had a high incidence and high mortality in post-renal-transplant population.Therefore,attention should be given to its differential diagnosis in clinical practice.Balancing anti-tuberculosis and anti-rejection therapy is important for this specific population. Key words: Kidney transplantation; Tuberculosis; Extra-pulmonary