P1720POSTTRANSPLANT TUBERCULOSIS IN LIVE DONOR RENAL TRANSPLANTATION : A SINGLE-CENTER EXPERIENCE

Autor: Mohamed Hamed Abbas, Ayman F. Refaie, Ahmed Mohamed Naguib Attiya, Ahmed M. Abdel-Rahman
Rok vydání: 2020
Předmět:
Zdroj: Nephrology Dialysis Transplantation. 35
ISSN: 1460-2385
0931-0509
Popis: Background and Aims Tuberculosis (TB) is one of the not uncommon serious bacterial infections which affect renal transplant recipients notably in endemic areas. Posttransplant TB occurs peculiarly due to reactivation of latent infection in the recipient or acquiring de novo infection after transplantation or rarely as donor transmitted infection. The aim of this study is to investigate the impact of TB disease and treatment drugs on renal graft and assess the risk factors for graft dysfunction during and after course of treatment. Method This retrospective single-center study investigated 3000 patients who underwent live donor renal allograft transplantation in our center between the years 1988-2019. TB diagnosis was confirmed in 44 patients. All proven-TB patients were evaluated regarding pretransplant demographic and immunological data. Posttransplant evaluation included kidney function tests, immunosuppressive therapy regimens, incidence of rejection episodes and anti-rejection therapies before, during and after TB. Results Patients were predominantly young (32±9.8 years), male (60%), There was no significant difference regarding other pretransplant demographic and immunological data. Regarding induction therapy, 13 patients received induction therapy; 7 patients received ATG, 6 patients received basiliximab and 31 patients did not receive induction therapy with no significant difference (p=0.07). Concerning maintenance immunosuppressive agents, no significant difference was found regarding different protocols of immunosuppression (p=0.11); however, regarding total dose of the steroid in 1st three months post-transplant, there was significant difference (p=0.017). As regards to rejection episodes, 16 patients were not exposed to rejection episodes before TB, 27 patients developed cellular rejection and only 1 patient developed humoral rejection with no statistical difference (p=0.18). In reference to management of rejection episodes, 25 patients received pulse steroid, 2 patients received pulse steroid and ATG, 1 patient received pulse steroid and plasma exchange (p=0.28) prior to infection with TB with no significant difference. A significant increase was noticed in serum Cr during TB disease and treatment:1.5 mg/dL at baseline (Crbase), 1.8 mg/dL at diagnosis (P=0.43 vs. Crbase), and 2.0 mg/dL during the peak (P=0.03 vs. Crbase). Conclusion Posttransplant TB drastically affects kidney function and graft outcome. Cumulative steroid dose in the first 3 months may be considered a risk factor for TB.
Databáze: OpenAIRE
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