Epidemiology of tuberculosis after kidney transplantation in a developing country.

Abstract

Tuberculosis (TB) is a great challenge in kidney transplantation, and is often associated with high morbidity and mortality. The aim of this study was to evaluate the epidemiology, clinical manifestations, and impact of TB in kidney transplant (KT) recipients. We performed a retrospective analysis of a cohort of adult KT recipients from 2000 to 2012, with follow-up until July 2014. Among the 1737 KT recipients evaluated, 60 developed TB: a 5% cumulative incidence, and an incidence rate of 589.4 cases/100,000 patient-years. Median time to diagnosis was 13.4 months, with 40% of the cases occurring in the first year. New-onset diabetes was significantly associated with post-transplant TB (P = 0.018). Pulmonary TB represented 78% of the cases, including disseminated disease. Two patients received latent TB treatment and developed active infection. 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). TB continues to be a great challenge in KT, especially in developing countries, with significant impact on patient and graft survival.