Maria D Grijota1, Núria Montero2, Maria J Luque1, Maria Díaz-Jurado3, Núria Sabé4, Sandra Pérez-Recio1, Carlos Couceiro2, Laura Muñoz5, Josep M Cruzado2, Miguel Santin4. 1. Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), 08907, L'Hospitalet de Llobregat, Spain. 2. Service of Nephrology, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Department of Clinical Sciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain. 3. Service of Nephrology, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), 08907, L'Hospitalet de Llobregat, Spain. 4. Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), Department of Clinical Sciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain. 5. Service of Internal Medicine, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain, Department of Clinical Sciences, University of Barcelona, 08907, L'Hospitalet de Llobregat, Spain.
Abstract
BACKGROUND: Systematic screening for, and treatment of, latent tuberculosis (TB) infection is recommended prior to kidney transplant. However, little is known about patient compliance with, or the safety profile of, preventive therapies used in clinical practice. METHODS: This was a retrospective observational study of patients who were eligible for kidney transplant and evaluated for TB infection between January 2013 and June 2019 at the TB clinic of a tertiary care teaching hospital. All patient data were registered prospectively as part of our nurse-led program before kidney transplant. We assessed completion rates, tolerance with therapy, development of TB, and associated workload. RESULTS: In total, 1568 patients were referred to our TB clinic for evaluation. Preventive therapy was given to 385 patients and completed by 340 (88.3%). Of these, 89 (23.1%) experienced some intolerance, with 27 requiring full discontinuation. After a median follow-up of 45 months (1426 patient-years), 206 (53.5%) of the treated patients received a kidney transplant; only 1 patient, who failed to complete treatment, developed posttransplant TB (7.01 cases per 10, 000 patient-years; 95% confidence interval, 0.35-34.59). Extra nurse or medical visits were required by 268 (69.6%) patients. CONCLUSION: Despite the complexity and workload generated by patients with ESRD awaiting kidney transplant preventive therapy for TB is effective in most cases. Our experience provides important evidence on the feasibility of preventive therapy for TB before kidney transplant when delivered as part of a comprehensive nurse-led program. This article is protected by copyright. All rights reserved.
BACKGROUND: Systematic screening for, and treatment of, latent tuberculosis (TB) infection is recommended prior to kidney transplant. However, little is known about patient compliance with, or the safety profile of, preventive therapies used in clinical practice. METHODS: This was a retrospective observational study of patients who were eligible for kidney transplant and evaluated for TB infection between January 2013 and June 2019 at the TB clinic of a tertiary care teaching hospital. All patient data were registered prospectively as part of our nurse-led program before kidney transplant. We assessed completion rates, tolerance with therapy, development of TB, and associated workload. RESULTS: In total, 1568 patients were referred to our TB clinic for evaluation. Preventive therapy was given to 385 patients and completed by 340 (88.3%). Of these, 89 (23.1%) experienced some intolerance, with 27 requiring full discontinuation. After a median follow-up of 45 months (1426 patient-years), 206 (53.5%) of the treated patients received a kidney transplant; only 1 patient, who failed to complete treatment, developed posttransplant TB (7.01 cases per 10, 000 patient-years; 95% confidence interval, 0.35-34.59). Extra nurse or medical visits were required by 268 (69.6%) patients. CONCLUSION: Despite the complexity and workload generated by patients with ESRD awaiting kidney transplant preventive therapy for TB is effective in most cases. Our experience provides important evidence on the feasibility of preventive therapy for TB before kidney transplant when delivered as part of a comprehensive nurse-led program. This article is protected by copyright. All rights reserved.
Authors: Miguel Santin; Sandra Perez-Recio; Maria D Grijota; Luis Anibarro; Jose M Barcala; Maria L De Souza-Galvao; Paloma Gijon; Rafael Luque; Francesca Sanchez Journal: PLoS One Date: 2022-10-21 Impact factor: 3.752