Julien Gras1, Nathalie De Castro1, Claire Montlahuc2, Laure Champion3, Anne Scemla4, Marie Matignon5, Marie Lachâtre6, Laurent Raskine7, Nathalie Grall8, Marie Noëlle Peraldi9,10, Jean Michel Molina1,10. 1. Service de Maladies infectieuses et tropicales, APHP-Hôpital Saint Louis, Paris, France. 2. Service de Biostatistiques et Information médicale, Hôpital Saint Louis APHP, Paris ECSTRA Team, UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 3. Service de Néphrologie et transplantation rénale, APHP-Hôpital Bichat, Paris, France. 4. Service de Néphrologie et transplantation rénale, APHP-Hôpital Necker Enfants Malades, Paris, France. 5. Service de Néphrologie et transplantation rénale, APHP-Hôpital Henri Mondor, Créteil, France. 6. Service de Maladies infectieuses et tropicales, APHP-Hôpital Bichat, Paris, France. 7. Service de bactériologie, APHP-Hôpital Lariboisière, Paris, France. 8. Laboratoire de microbiologie, APHP-Hôpital Bichat, INSERM, IAME, UMR 1137, Paris, France. 9. Service de Néphrologie et transplantation rénale, APHP-Hôpital Saint Louis, Paris, France. 10. Université Paris Diderot-Paris VII, Paris, France.
Abstract
OBJECTIVES: Tuberculosis (TB) is a rare but life-threatening infection after solid organ transplant. The present study was undertaken to assess the clinical features, risk factors, and outcome of TB after kidney transplantation in a low-prevalence area. METHODS: We conducted a retrospective study, describing all kidney transplant recipients diagnosed with TB between 2005 and 2015 in 3 French centers. For each TB case, 2 controls without TB were identified and matched by center, age, transplant date, and birth country. Risk factors associated with TB were identified and survival estimated. RESULTS: Thirty-two cases and 64 control patients were included among 3974 transplantations. The prevalence of TB was 0.83%. Median age at the time of diagnosis was 64 years; 75% were born in a high TB prevalence country, but only 3 had received isoniazid prophylaxis for latent TB infection. TB occurred at a median of 22 months after transplantation. On diagnosis, 66% had disseminated infection. Median duration of treatment was 9 months. Immunosuppressive therapy changes were necessary in all patients because of drug-drug interactions. Among cases, 5 deaths occurred during follow-up (median duration: 41 months), one directly related with TB. Survival was significantly lower in transplant recipients with TB, as compared to controls (P = .001). No predictive factors of tuberculosis after transplantation were statistically significant in univariate analysis. CONCLUSION: TB in kidney transplant recipients is a rare and late event, but is associated with significantly reduced survival. Our results emphasize the need for systematic screening for LTBI, followed by IPT in high-risk patients.
OBJECTIVES:Tuberculosis (TB) is a rare but life-threatening infection after solid organ transplant. The present study was undertaken to assess the clinical features, risk factors, and outcome of TB after kidney transplantation in a low-prevalence area. METHODS: We conducted a retrospective study, describing all kidney transplant recipients diagnosed with TB between 2005 and 2015 in 3 French centers. For each TB case, 2 controls without TB were identified and matched by center, age, transplant date, and birth country. Risk factors associated with TB were identified and survival estimated. RESULTS: Thirty-two cases and 64 control patients were included among 3974 transplantations. The prevalence of TB was 0.83%. Median age at the time of diagnosis was 64 years; 75% were born in a high TB prevalence country, but only 3 had received isoniazid prophylaxis for latent TB infection. TB occurred at a median of 22 months after transplantation. On diagnosis, 66% had disseminated infection. Median duration of treatment was 9 months. Immunosuppressive therapy changes were necessary in all patients because of drug-drug interactions. Among cases, 5 deaths occurred during follow-up (median duration: 41 months), one directly related with TB. Survival was significantly lower in transplant recipients with TB, as compared to controls (P = .001). No predictive factors of tuberculosis after transplantation were statistically significant in univariate analysis. CONCLUSION: TB in kidney transplant recipients is a rare and late event, but is associated with significantly reduced survival. Our results emphasize the need for systematic screening for LTBI, followed by IPT in high-risk patients.
Authors: Elie Azoulay; Lene Russell; Andry Van de Louw; Victoria Metaxa; Philippe Bauer; Pedro Povoa; José Garnacho Montero; Ignacio Martin Loeches; Sangeeta Mehta; Kathryn Puxty; Peter Schellongowski; Jordi Rello; Djamel Mokart; Virginie Lemiale; Adrien Mirouse Journal: Intensive Care Med Date: 2020-02-07 Impact factor: 17.440
Authors: Lúcio R Requião-Moura; Elizabeth De Francesco Daher; Cassio R Moreira Albino; Savio de Oliveira Brilhante; Geraldo Bezerra da Silva Junior; Silvana Daher Costa; Tainá Veras de Sandes-Freitas Journal: Am J Trop Med Hyg Date: 2021-06-28 Impact factor: 3.707