Tuberculosis in Iranian Kidney Transplant Recipients: A Single-Center Experience

Introduction. Renal transplantation recipients are at a high risk of developing tuberculosis
(TB) following transplantation, especially in developing countries, with high incidences
of morbidity and mortality. In this report, we examined the risk factors and impact
of TB on the outcome of kidney transplantation.
Patients and methods. Among 1350 living donor Iranian kidney transplantations, 52
(3.9%) had TB diagnosed in various organs. Of these, 7 (13.5%) had TB pretransplantation
and 40 (76.9%) were men. The overall mean age was 32.6 � 10.5 years.
Results. The interval between transplantation and diagnosis was 54.6 � 48.23 (range 4
to 140) months. In 34 (65.6%) patients TB was diagnosed after the first year posttransplantation.
Pleuro/pulmonary TB was the most common form (68%). All posttransplant
TB patients received a quadriple antituberculosis therapy; pyrazinamide, rifampicin,
ethambutol, and isoniazide). Hepatotoxicity was seen in 16 (30%) patients, including 12
mild cases with normalization after temporary withdrawal of isoniazide and rifampicin, and
four were severe, but mortality was not attributable to hepatocellular failure. Twelve
patients (23%) died. Chronic allograft dysfunction occurred in 34 (65%) patients, 19
(37%) with graft loss. Pre-TB patients showed comparable posttransplant courses.
Conclusion. TB is a common infection among renal transplant recipients in developing
countries. The peak incidence is after the first year of transplantation and mortality is
considerable. Hepatoxicity is a considerable risk of treatment, possibly as a result of
additive toxic effects of immunosuppressive drugs. Chronic allograft nephropathy is a
serious complication that has a negative impact on the graft survival