TUBERCULOSIS INFECTION AFTER RENAL TRANSPLANTATION

İn this study, renal transplant recipients who were complicated with tuberculosis, were analyzed with special reference to prevalence, outcome, therapy and drug toxicity. Among 520 patients, 22 (4.2%) were diagnosed to be complicated with various organ tuberculosis. The time interval between transplantation and diagnosis of tuberculosis was 44.5 ±33.5 (range 3 to 111) months. In 18 (82%) of the patients, tuberculosis was detected after the first year of transplantation. The most common form was pleuro/pulmonary tuberculosis (54%), but various localisations such as liver, jejunum, bone and urogenital tract were also noted. Six (30%) of the patients were presented with fever oj unknown origin, while the others complained from low grade fever, constitutional symptoms and symptoms related with the involved organs. Sixteen of the 22 patients responded favorably to the treatment and improved with excellent allograft function, whereas 6 (27.2%) were lost. Two of the patients returned to hemodialysis within the following 6 months of antituberculosis therapy. Toxic hepatitis was seen intensif 4 (18%) patients, and one was complicated with acute hepatocellular failure. As compared to pretreatment period, cyclosporine dose was increased about 0.5 to fourfold inlO of the patients in order to achieve the aimed serum levels and reached the stable serum drug levels in nearly 4 weeks after instutition of rifampicin. 

It was concluded that, tuberculosis, is a common infection in renal transplant recipients, especially after the first year of transplantation and may result in significant mortality and morbidity. Close follow-up of the patients especially during the first month of antituberculosis therapy, could effect the patient and graft survival rates favourably.