POS-077 RISK FACTORS AND OUTCOMES OF TUBERCULOSIS IN INDIAN KIDNEY TRANSPLANT RECIPIENTS

Abstract

Tuberculosis (TB) is one of the commonest opportunistic infections in kidney transplant recipients and can have diverse clinical presentations leading to a delay in the diagnosis. We evaluated risk factors, clinical presentation, impact of TB on patient, and the graft outcomes. We studied 703 kidney transplant recipients from 1985-2018 at a tertiary care centre in western India. Demographic details, past history of TB, immunosuppression regimens, time to diagnosis of tuberculosis post-transplant, clinical presentations, duration of treatment, adverse effects of treatment, and its outcome on patient and graft were studied. Tuberculosis was diagnosed in 103 recipients (14.6%) post-transplant. The mean (SD) age of recipients was 35.12±10 years, with 93 (90.2%) being males and 102 recipients (99.1%) from a living donor. Nineteen recipients (18.4%) had tuberculosis before transplant. The median (IQR) time to diagnosis of TB post-transplant was 24 months (8-48). In 41(39.8%) recipients, development of tuberculosis was preceded by anti-rejection therapies. Pulmonary involvement was the most common organ involvement in 72 recipients (69.9%), extrapulmonary in 31 (30%) and disseminated in 2 (1.9%). Among the extrapulmonary involvements, gastrointestinal involvement was seen in 9 recipients (8.7%) followed by musculoskeletal in 7(6.8%), lymphadenitis in 6 (5.8%), central nervous system in 3 (2.9%), cutaneous involvement in 2 (1.9%), genitourinary TB in 1 (0.9%) and transplant kidney in 1 (0.9%). The median (IQR) duration of treatment was 12 months (5-18). Four recipients had relapses after completion of treatment. Adverse effects of treatment included transaminase elevation seen in 38 (38.6%) recipients followed by acute gastritis in 19 (18.4%), hyperuricemia in 17 (16.5%) and sensorineural hearing loss in 3 (2.9%). Multidrug-resistant TB was diagnosed in 3 recipients (2.9%). The pre-transplant median (IQR) dialysis vintage was 8 months (6-12). New onset diabetes after transplant was the most common comorbidity observed in 28 (27.18%) recipients, followed by Hepatitis C in 16 (15.55%), Hepatitis B in 12 (11.6 %), Cytomegalovirus (CMV) in 6(5.8%) and HIV in 2 recipients (1.9%). Immunosuppressive regimens at time of transplant included azathioprine in 61 recipients (59.2%), mycophenolate mofetil in 40(38.8%), tacrolimus in 38(36.8%), cyclosporine in 26(25.2%) and steroids in 103(100%) recipients. Acute graft dysfunction during treatment was seen in 42 recipients (40.7%). Three recipients (2.9%) developed graft failure. Seventy-two recipients (69.9%) survived after treatment, 16 (15.5%) expired due to TB, and 15(14.5%) were lost to follow-up. Tuberculosis remains a common infectious complication after kidney transplant and is associated with significant morbidity and mortality.