Tuberculosis in renal transplant recipients

Background. Tuberculosis is an important cause of morbidity and mortality i n renal transplant recipients, but there are insufficient data regarding th e efficacy and complications of therapy and of INH prophylaxis. Methods. This study is a retrospective review of the records of 880 renal t ransplant recipients in two centers in Turkey. Results. Tuberculosis developed in 36 patients (4.1%) at posttransplant 3-1 11 months, of which 28 were successfully treated. Eight patients (22.2%) di ed of tuberculosis or complications of anti-tuberculosis therapy. Use of ri fampin necessitated a mean of a fold increase in the cyclosporine dose, but no allograft rejection occurred due to inadequate cyclosporine levels. Hep atotoxicity developed in eight patients during treatment, two of whom died due to hepatic failure. No risk factor, including age, gender, renal dysfun ction, hepatitis C, or past hepatitis B infection, was found to be associat ed with development of hepatic toxicity, A subgroup of 36 patients with a p ast history of or radiographic findings suggesting inactive tuberculosis, w as considered to be at high risk for developing active disease, of whom 23 were given isoniazid (INH) prophylaxis, None versus 1 of 13 (7.7%) of cases with and without INH prophylaxis, respectively, developed active disease ( P>0.05). None of the patients receiving INH had hepatic toxicity or needed modification of cyclosporine dose. Conclusions. These data show that tuberculosis has a high prevalence in tra nsplant recipients, that it can effectively be treated using rifampin-conta ining antituberculosis drugs with a close follow-up of serum cyclosporine l evels, and that INH prophylaxis is safe but more experience is needed to de fine the target population.