Risk factors and characteristics of post-transplant tuberculosis in an endemic area

Abstract

Background: Tuberculosis (TB) is a major post-transplant concern in endemic areas. This report summarizes the clinical characteristics, risk factors, and effects of post-transplant TB on graft and patient survival at a single center in Korea. Material/Methods: We retrospectively analyzed data from 2799 kidney recipients at Yonsei University Health System between April 1979 and August 2008 to determine the incidence, outcome, and risk factors affecting the development of TB infections and the effect of TB on graft and patient survival rates. Results: TB developed in 144 (109 males and 35 females; mean age, 37±12 years) out of 2799 (5.1%) recipients. Newly developed TB occurred in 116 recipients (81%) and recurrent TB occurred in 28 (19%) recipients with a pre-transplant history of a mycobacterial infection. The mean interval to TB diagnosis was 55.6±47.9 months after transplantation without a peak interval incidence for 8 years after transplantation. Based on Cox regression analysis, a history of TB was the strongest risk factor (hazard ratio [HR] =11.618) affecting the development of TB. TB negatively affected graft and patient survival after kidney transplantation. Non-pleurisy extrapulmonary and miliary TB resulted in inferior treatment results and a poor prognosis in the early treatment period. Conclusions: A history of TB is the strongest predictor of post-transplant TB. Therefore, patients with a pre-transplant history of TB should be carefully monitored.