Tuberculosis in renal transplant recipients on isoniazid prophylaxis

Abstract

Background: The incidence of Tuberculosis (TB) in renal transplant recipients in Pakistan is 15%. Following findings of our randomized controlled trial 1 showing an overwhelming benefit of Isoniazid (INH) prophylaxis, from June 2009 every transplant recipient receives INH for one year post transplant in our unit. Aims and objectives: To find out incidence, risk factors and complications of tuberculosis in renal transplant recipients receiving INH prophylaxis. Methods: We reviewed the records of all renal transplant recipients on INH prophylaxis from June 2009 to December 2011, followed up till June 2015. We noted details of transplantation and immunosuppression, Tuberculosis including occurrence after transplantation, site, methods of diagnosis, treatment, drugs side effects and other complications, and outcome. Results: Out of 910 recipients, 91% completed one year of INH. Forty six (5%) developed TB, incidence higher in later than 2 years post transplantation than earlier. Majority were pulmonary (48%); most were diagnosed on cultures. Out of 14 positive cultures, only one (7%) was INH resistant. Out of 46 patients with TB, majority (84%) were cured, 6 (13%) died while one suffered graft failure. Incidence of hepatotoxicity was 1.42%. Conclusion: INH prophylaxis is effective in preventing TB in post renal transplant recipients. Late development of TB still remains a challenge. 1 Use of isoniazid chemoprophylaxis in renal transplant recipients. Rubina Naqvi et al. Nephrol. Dial. Transplant. (2010) 25 (2): 634-637.