Successful kidney re-transplantation in a patient with previous allograft kidney tuberculosis

TitleSuccessful kidney re-transplantation in a patient with previous allograft kidney tuberculosis
Publication TypeJournal Article
Year of Publication2004
AuthorsSiu YP, Tong MK, Leung KT, Yung CY
JournalTransplant infectious disease : an official journal of the Transplantation Society
Pagination132 - 5
Date PublishedSep
Type of ArticleCase Reports
ISSN1398-2273 (Print) 1398-2273 (Linking)
Accession Number15569231
Keywords*Kidney Transplantation, Adult, Antitubercular Agents / therapeutic use, Ethambutol / therapeutic use, Humans, Immunosuppression / adverse effects, Isoniazid / therapeutic use, Male, Opportunistic Infections / *transmission, Pyrazinamide / therapeutic use, Reoperation, Rifampin / therapeutic use, Tuberculosis, Renal / drug therapy / *transmission

Opportunistic infections, and in particular tuberculosis (TB), carry substantial morbidity and mortality in solid organ transplant recipients. We report a 39-year-old man who underwent a cadaveric renal transplant. Three months postoperatively, he was diagnosed to have tuberculous infection of his graft kidney manifested as fever and renal impairment. The diagnosis was confirmed by renal biopsy, which showed granuloma formation and positive stain for acid-fast bacilli (AFB). His systemic symptoms responded well to a complete course of anti-tuberculous therapy, but his renal function continued to deteriorate. Graft nephrectomy was performed and the patient underwent a second kidney transplant 1 year later. He remained well and asymptomatic thereafter. No signs of recurrence of tuberculous infection were noted up until the present time. This case illustrates that TB remains an important threat to transplant recipients. Although reactivation of dormant TB is the usual mode of infection, acquisition from the donor graft is also possible. The latter may account for the infection in our case, as our patient had a negative tuberculin skin test and normal chest radiograph prior to transplant. The identification of AFB in the kidney graft less than 3 months postoperatively also suggested that causal relationship. While diagnosing TB in post-transplant recipients is difficult and may require renal biopsy, as in our case, treatment on the other hand is no different from the standard protocols. However, no consensus has been reached on the safety of re-transplantation. Also, the need for graft nephrectomy and chemoprophylaxis remains unclear.

Alternate JournalTranspl Infect Dis
Notify Library Reference ID1420

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