Diagnostic and therapeutic challenges of tuberculosis in kidney transplant recipients; a case series study

Abstract

Introduction: One of the most serious bacterial infections following kidney transplantation is tuberculosis (TB). Immunosuppressive medications and anti-tuberculosis therapy (ATT) frequently interact with one another and cause adverse effects. This case series focuses on kidney transplant patients who have active TB, with varying clinical manifestations and outcomes. Case-1: A 42-year-old man with end-stage renal disease (ESRD) underwent a kidney transplant from an unrelated living donor. He was diagnosed with disseminated TB post-transplant. Third-month post-ATT, serum creatinine was increased. His kidney allograft failed and required hemodialysis, but he died. Case-2: A 31-year-old female with ESRD underwent a kidney transplant from an unrelated living donor. She was diagnosed with pulmonary TB post-transplant. Third-month post-ATT, her tacrolimus decreased significantly; however, her kidney allograft remained stable and still alive. Case-3: A 29-year-old male with ESRD underwent a kidney transplant from an unrelated living donor. He was diagnosed with pulmonary TB post-transplant. Third-month post-ATT, tacrolimus levels decreased significantly but her kidney allograft remained stable. Case-4: A 60-year-old man with ESRD underwent a kidney transplant from an unrelated living donor. He was diagnosed with Disseminated TB post-transplant. Third-month post-ATT, tacrolimus levels decreased significantly’ since, her kidney allograft remained stable. Conclusion: After kidney transplantation, TB might be difficult to diagnose and treat because of its unusual symptoms and varying outcomes. During the first three months of ATT, there may be significant interactions between tacrolimus and ATT. Therefore, frequent and careful monitoring along with medication modifications are required. Tuberculosis prophylaxis is essential for recipients after transplantation, particularly in endemic countries.

Keywords

• kidney transplantation
• kidney allograft function
• tuberculosis
• therapy