Tuberculosis in southern Chinese renal‐transplant recipients

Abstract

To analyze the characteristics of tuberculosis (TB) in Southern Chinese renal transplant recipients, and summarize the corresponding experiences in diagnosis and management. Retrospectively study 41 documented post-transplant TB cases out of the 2333 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan. 1991 and Apr. 2007. TB in the post-renal-transplant population in Southern China displayed the following characteristics: (i) high incidence within a short time after transplantation, the median interval between renal transplantation and diagnosis of TB was 8 months (range: 1-156 months) and 56.1% were diagnosed within the first year post-transplant; (ii) high prevalence (51.2%) of extra-pulmonary tuberculosis; (iii) high co-infection rate (19.5%), pathogens included candida albicans, pseudomonas aeruginosa, staphylococcus aureus, Acinetobacter haemolyticus and cytomegalovirus; (iv) fever (82.9%), cough (56.1%) and sputum (39.0%) are the most common clinical manifestations; (v) purified protein derivative of tuberculin (PPD) skin test had little diagnostic value in this group with a negative result in all 41 cases; (vi) acute rejection (29.3%) and liver function damage (17.1%) were the main adverse effects of anti-tuberculosis chemotherapy; (vii) mortality of patients with post-transplant tuberculosis reached up to 22.0%. Chinese renal transplant recipients face a high risk of TB because of their immuno-compromised state and epidemiological prevalence of the disease. Therefore, attention should be given to this differential diagnosis in clinical practice. Balancing the benefits and disadvantages of anti-tuberculosis chemotherapy is of importance for this specific population.