Tuberculosis in renal transplant patients: The experience of a single center in Medellín-Colombia, 2005-2013

• Main Authors: Lina Maria Serna Higuita, John Fredy Nieto-Ríos, Salomon Daguer-Gonzalez, Catalina Ocampo-Kohn, Arbey Aristizabal-Alzate, Catalina Velez-Echeverri, Juan Jose Vanegas-Ruiz, Isabel Ramirez-Sanchez, Jhon Jairo Zuleta Tobon, Gustavo Adolfo Zuluaga-Valencia
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Nefrologia 2014-12-01
• Series: Brazilian Journal of Nephrology
• Subjects: mycobacterium tuberculosis; rejeição de enxerto; transplante de rim
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002014000400512&lng=en&tlng=en

Introduction: Tuberculosis is a common opportunistic infection in renal transplant patients. Objective: To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital. Methods: Retrospective and descriptive study. Results: In 641 renal transplants, tuberculosis was confirmed in 12 cases. Of these, 25% had a history of acute rejection, and 50% had creatinine levels greater than 1.5 mg/dl prior to infection. The disease typically presented as pulmonary (50%) and disseminated (33.3%). The first phase of treatment consisted of 3 months of HZRE (isoniazid, pyrazinamide, rifampicin and ethambutol) in 75% of the cases and HZME (isoniazid, pyrazinamide, moxifloxacin and ethambutol) in 25% of the cases. During the second phase of the treatment, 75% of the cases received isoniazid and rifampicin, and 25% of the cases received isoniazid and ethambutol. The length of treatment varied between 6 and 18 months. In 41.7% of patients, hepatotoxicity was associated with the beginning of anti-tuberculosis therapy. During a year-long follow-up, renal function remained stable, and the mortality rate was 16.7%. Conclusion: Tuberculosis in the renal transplant population studied caused diverse nonspecific symptoms. Pulmonary and disseminated tuberculosis were the most frequent forms and required prolonged treatment. Antituberculosis medications had a high toxicity and mortality. This infection must be considered when patients present with a febrile syndrome of unknown origin, especially during the first year after renal transplant.