Arreola-Guerra JM, Pérez-Cesari M, Ávila R, Gómez JA, Villasis-Keever A, Sifuentes-Osornio J

Language: English
References: 22
Page: 52-58
PDF size: 244.72 Kb.

ABSTRACT

Background: The recipients of a renal transplant have a 50-100 times greater probability to develop active tuberculosis. The use of isoniazid has proven to decrease the reactivation frequency in high-risk patients. In this study we assess adherence to a prevention program of tuberculosis and outcomes in patients who are renal transplant recipients at tertiary care center located in Mexico City. Material and methods: At the end of 2003 we reviewed and updated the prevention and treatment program of tuberculosis (Tb) in candidates for a renal transplant. The program includes: 1) risk assessment before the transplant: clinical history, tuberculin skin test (TST), radiographic studies and mycobacterial cultures; 2) treatment of high-risks patients: isoniazid for six months in cases of latent Tb (LTb), defined as positive TST (over 5 mm) with no clinical evidence of the disease; 3) treatment of patients with demonstrated active tuberculosis. A revision was conducted of the files of all the patients who received a renal transplant from January 2004 to December 2009. We assessed adherence to the program, the frequency of LTb and active Tb during the follow up period. Results: All the files of the 230 patients who received a renal transplant in the study period were reviewed. 55% were men, with a mean age of 33.9 ± 11.9 years; 74.2% were kidney transplant recipients from a living donor, and 91.6% received induction immunosuppressive therapy. Assessment of tuberculosis risk: 30.4% (70/230) of the patients had TST + (› 5 mm), only 17 (8.1%) had a history of exposure and eight (3.8%) of previous Tb infection. 3.9% (9/230) of the chest radiographies had findings pointing to Tb, however a Chest CT was conducted in 22 patients, out of which six (27%) showed findings of pulmonary Tb and only one of these was diagnosed active disease, with ganglionar involvement. Pre-transplant treatment of high-risk patients: 98.5% (69/70) of the patients with LTb received isoniazid, two of them suspended it before the end of six months due to poor adherence. In addition one case was diagnosed with active Tb and treated accordingly. Incidence of tuberculosis: During the follow up period [(average of 49.6 m (3.6-72)], there was only one case of splenic tuberculosis in a patient in hemodialysis previously treated for humoral rejection which included rituximab. Conclusions: A complete assessment of the risk for developing tuberculosis is carried out in our Institution to all patients who are candidates for renal transplantation. All high-risk patients received isoniazid with good tolerance. Despite the high prevalence of TST+ there is a very low incidence of tuberculosis and this is probably due to proper pre-transplant screening and the treatment of LTb for six months in nearly all high-risk patients.

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