Analysis of the clinical characteristics of 100 patients who developed tuberculosis after renal transplantation.

Abstract

Background: The early clinical diagnosis of tuberculosis (TB) in kidney transplant recipients is difficult, and TB is one of the major infectious disease-related causes of morbidity and death in transplant recipients. This study analyzed the characteristics of patients who developed TB after renal transplantation in an effort to improve the diagnosis and treatment of such patients.

Methods: This retrospective study examined 100 patients who developed TB after kidney transplantation, and received treatment at the Hunan Chest Hospital from January 2014 to January 2024. The clinical characteristics of patients were examined, including general condition, date of TB onset, clinical manifestations, site of TB, immunological indicators, method of etiological detection, imaging findings, treatment, and outcome.

Results: Secondary pulmonary TB was the most common diagnosis overall (n = 76), and abdominal TB was the most common type of extrapulmonary TB (n = 8). Eighty-eight patients were tested by the interferon-gamma release assay (IGRA); 72 (81.8%) had positive results, 13 (14.8%) had negative results, and 3 (3.4%) had uncertain results. Twenty-six patients received the tuberculin skin test (TST); 7 (26.9%) had positive results and 19 (73.1%) had negative results. The overall etiological detection rate was 58.0%. Analysis of factors associated with outcome showed that patients who received an intensive phase regimen of isoniazid + rifampicin + ethambutol + moxifloxacin were more likely to achieve cure than those who received an intensive phase regimen of isoniazid + rifampicin + ethambutol + pyrazinamide (P < 0.05).

Conclusions: Patients who develop TB after renal transplantation have atypical symptoms and imaging findings. In addition to conventional detection methods, the IGRA, TST, and invasive examinations may aid in diagnosis. An intensive-phase anti-TB regimen of isoniazid + rifampicin + ethambutol + moxifloxacin appeared to provide a better prognosis in these patients.