A comparative study of clinical outcomes and risk factors of tuberculosis in kidney transplant recipients from deceased donors.

Objective: To investigate the clinical characteristics, diagnosis and treatment of tuberculosis infection after deceased donor kidney transplantation and to analyze the risk factors and prognosis of tuberculosis infection through a paired case-control study.

Methods: This study investigated 31 kidney transplant recipients who developed tuberculosis among 2185 total recipients during 2012-2021. We employed a 1:1 paired case-control design, utilizing 31 patients who received kidneys from the same donor as the controls. The study analyzed clinical presentation, diagnosis, treatment, risk factors, and prognosis.

Results: This study identified a 1.4% incidence of tuberculosis (TB) infection (31/2185) in kidney transplant recipients. The median onset was 10.8 months post-transplant (range: 5-24 months), with 51.6% occurring within the first year. Anti-TB therapy achieved cure in 30 patients, but one died and three experienced kidney transplant dysfunctions. While overall patient survival was not statistically different between groups, kidney graft survival was significantly lower in the TB group (p = 0.042). While kidney function was initially similar, the TB group experienced significant declines in creatinine and GFR at 3, 6, and 12 months post-treatment (p < 0.05). Multivariate analysis identified diabetes mellitus (p = 0.005) and hepatitis (p = 0.027) as independent risk factors for post-transplant TB infection.

Conclusion: Over half of the tuberculosis cases (51.6%) occurred within the first year post-transplant, highlighting the need for heightened vigilance during this early period. While standard anti-TB therapy achieved good overall patient survival, it takes a toll on kidney function which underscores the importance of close kidney function monitoring and delicate immunosuppressant management during TB treatment. Diabetes mellitus and hepatitis were identified as independent risk factors for post-transplant TB infection. Prophylaxis measures should be considered for these high-risk patients during early time post-transplant.