Clinical Spectrum and Outcomes of Tuberculosis in Kidney Transplant Recipients

Background: Infectious complications are a leading cause of morbidity and mortality after kidney transplant in India. One of the most common infections after kidney transplant is tuberculosis (TB), in developing countries. Incidence of tuberculosis is 20-74 times more common in solid organ transplant recipients than the general population. The overall incidence, depending upon the endemicity of the region can range between 0.5 % to 15.2 %. We analysed our data of post-transplant TB between Jan 2012- Dec 2023. Methods: A retrospective analysis of 2800 patients who underwent kidney transplant between January 2012 to December 2023 was conducted. Patients who were started on anti-tubercular treatment (ATT) in the pre-transplant period and those who were empirically started on ATT were excluded. Demographic data, details regarding the peri-transplant period, immunosuppression and post-transplant events like other infections, rejection episodes and graft function were analysed till last follow-up. Results: A total of 109 patients (Incidence 3.9%) had microbiologically/histopathologically confirmed evidence of tuberculosis in the post-transplant period. The median duration of onset of tuberculosis in the post-transplant period was 22 months. Extra-pulmonary tuberculosis was seen in 71.5% of the patients, the most common presentation was tubercular lymphadenopathy followed by tubercular pleural effusion. Eight patients had disseminated tubercular infection and one patient had tuberculosis of the graft kidney. Three out of the 109 patients had MDR tuberculosis. The mortality was 4.5 % in these patients Conclusion: Even with the various national and international campaigns to end tuberculosis, it continues to be an important infectious complication, in the post-transplant period in Indi. Timely diagnosis and treatment is key to reduce morbidity and mortality associated with tuberculosis in post-transplant period.