P156 A London centre based review of tuberculosis post kidney transplantation

Abstract

<h3></h3> The incidence of active tuberculosis (TB) post renal transplantation is much higher than the general population. This has previously been described as presenting in the first year following solid organ transplantation and is predominantly due to reactivation of latent TB infection (LTBI)(1). Diagnosis can be challenging in this patient group who may present with atypical presentations or extra-pulmonary infection. Our aim was to assess the active TB incidence in our post renal transplant population. In our London based renal transplant centre, retrospective data was collected including demographic data, site of disease and culture positivity. Electronic patient records and our TB database was analysed for case details for rates of active TB. A total of 2311 patients received renal or simultaneous pancreas kidney transplantation between November 2005 and July 2019. At the time of analysis all patients had at least one year follow up post renal transplantation. In total, 8 patients were treated for active TB. Of these patients the median time to TB diagnosis was 4.35 years (IQR 1.125–6.2). None were screened for latent TB but 4 were on prophylactic isoniazid 150 mg od at the time of diagnosis; of which 2 developed isoniazid resistant disease. A total of 3 cases were culture confirmed tuberculosis. 6/8 cases were extra-pulmonary TB. There was 1 graft rejection and 2 graft losses, none were attributed to TB. In our cohort, the rate of TB remains comparable to historic data (cumulative rate of 0.36%) however the time to diagnosis was longer than expected, suggesting possible re-exposure. Within our patients who received chemoprophylaxis, there was a high rate of isoniazid resistance. We have worked towards improving pre-transplant screening, appropriate interferon gamma release assay (IGRA) assessment in addition to standardising latent TB treatment. Patients with previous TB or at high risk due to ethnic or geographical background receive TB prophylaxis with isoniazid 300 mg OD and pyridoxine 50 mg once a week for 1 year post transplant. <h3>Reference</h3> Abad CLR, Razonable RR. Mycobacterium tuberculosis after solid organ transplantation: A review of more than 2000 cases. <i>Clin Transplant</i>. 2018;<b>32</b>(6):e13259. doi:10.1111/ctr.13259