Mycobacterium tuberculosis infections after renal transplantation

The incidence of tuberculosis was found to be 5.8% (16/274) in 274 kidney g raft recipients in our centre between 1986 and 1998, The kidney recipients were evaluated retrospectively. A total of 51 recipients received isoniazid prophylaxis for 6 months. The prevalence of tuberculosis was found similar (6% vs. 8,8%, p = 0.15) between recipients with prophylaxis and no prophyl axis, Eight patients were recipients of cadaveric donor kidneys and 8 were recipients of living donor kidneys. Lungs were the most frequently affected site, as in the normal population. M, tuberculosis grew in 7 patients. In 5 patients, M. tuberculosis was also detected on direct microscopy and poly merase chain reaction. In 4 patients, diagnosis was made on clinical ground s and later confirmed by positive response to therapy. In 8 patients, invas ive procedures were performed for diagnosis. Five patients had miliary tube rculosis at the time of diagnosis. In 3 patients dissemination occurred dur ing follow-up. Nine patients responded to anti-tuberculous therapy while st ill preserving their graft function, 1 patient rejected the graft while und er treatment and returned to haemodialysis. Five patients (31%) died. Since the risk of dissemination of tuberculosis is high in these patients, anti- tuberculous therapy should be started whenever clinical findings suggestive of tuberculosis are present, even in the absence of any microbiological an d/or histological evidence.