Introduction: Tuberculosis (TB) is a widespread infection in Indian subcontinent. It is a feared complication in post-transplant period. Reactivation rather than primary infection is a common mode of activation of TB after kidney transplantation (KT). In this study, we report profile of post-kidney transplant TB from central India.
Methods: We searched the electronic database of our transplant unit to include the patients who developed TB after kidney transplantation (KT). Outcomes after antitubercular therapy (ATT) were assessed.
Results: Out of total 165 prevalent KT patients, 10 (6.1%) developed post-transplant TB. Nine (90%) cases were diagnosed with TB GeneXpert and one had sputum positivity for AFB. Pulmonary (70%) followed by genitourinary (20%) and lymph node (10%) were the focus of TB infection. One patient also had tubercular abscess in kidney allograft. Two (20%) patients had concomitant pulmonary Aspergillosis. TB occurred within a year after transplant in 50% of patients. Five (50%) had received induction with anti-thymocyte globulin. One (10%) patient had received Rituximab prior to transplant. Rifampin-free ATT was used in 3 (30%) patients. ATT was successful in 9 (90%) cases whereas it is ongoing for one patient. One patient developed Ethambutol related optic neuropathy. Two (20%) patients had graft dysfunction at the diagnosis of post-transplant TB which recovered with ATT. One (10%) developed mixed acute antibody and cell mediated rejection after initiating ATT. One (10%) patient suffered from graft loss after TB.
Conclusion: TB is an endemic disease in India. Post-transplant TB poses significant challenges in management due to immunosuppression and drug interactions. Timely diagnosis helps in successful treatment of TB. Compliance to ATT is of prime importance to achieve optimal patient outcomes.