Brazilian Journal of Nephrology (Dec 2014)

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

  • 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

DOI
https://doi.org/10.5935/0101-2800.20140073
Journal volume & issue
Vol. 36, no. 4
pp. 512 – 518

Abstract

Read online

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.

Keywords