Clinical characteristics, risk factors, and outcome of tuberculosis in kidney transplant recipients: A multicentric case‐control study in a low‐endemic area. Issue 5 (28th June 2018)

• Record Type: Journal Article
• Authors: Gras, Julien; De Castro, Nathalie; Montlahuc, Claire; Champion, Laure; Scemla, Anne; Matignon, Marie; Lachâtre, Marie; Raskine, Laurent; Grall, Nathalie; Peraldi, Marie Noëlle; Molina, Jean Michel
• Is Part Of: Transplant infectious disease. Volume 20:Issue 5(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-06-28
• Subjects: case‐control -- descriptive -- kidney transplantation -- risk factors -- tuberculosis; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12943
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Objectives: Tuberculosis (TB) is a rare but life‐threatening infection after solid organ transplant. The present study was undertaken to assess the clinical features, risk factors, and outcome of TB after kidney transplantation in a low‐prevalence area. Methods: We conducted a retrospective study, describing all kidney transplant recipients diagnosed with TB between 2005 and 2015 in 3 French centers. For each TB case, 2 controls without TB were identified and matched by center, age, transplant date, and birth country. Risk factors associated with TB were identified and survival estimated. Results: Thirty‐two cases and 64 control patients were included among 3974 transplantations. The prevalence of TB was 0.83%. Median age at the time of diagnosis was 64 years; 75% were born in a high TB prevalence country, but only 3 had received isoniazid prophylaxis for latent TB infection. TB occurred at a median of 22 months after transplantation. On diagnosis, 66% had disseminated infection. Median duration of treatment was 9 months. Immunosuppressive therapy changes were necessary in all patients because of drug‐drug interactions. Among cases, 5 deaths occurred during follow‐up (median duration: 41 months), one directly related with TB. Survival was significantly lower in transplant recipients with TB, as compared to controls ( P = .001). No predictive factors of tuberculosis after transplantation were statistically significant in univariate analysis. Conclusion: TB in kidney transplant recipients is a rare and late event, but is associated with significantly reduced survival. Our results emphasize the need for systematic screening for LTBI, followed by IPT in high‐risk patients.