Parra-Michel R, Soto-Vargas J, López-Iñiguez A

Language: Spanish
References: 0
Page: 5-11
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ABSTRACT

Introduction. Diagnosis and treatment of tuberculosis in patients receiving kidney grafts represent a series of challenges. Failure to reach an accurate and prompt diagnosis can lead to delayed treatment, and can be due to a negative tuberculin skin test, negative baciloscopy in spite of active disease and atypical clinical presentations of the disease. Recommendations for diagnosis and treatment for latent tuberculosis and active disease in kidney graft recipients are made according to guides made by experts in the field, with only a few controlled studies available regarding treatment of latent and active tuberculosis. In Mexico, clinical characteristics and risk factors for tuberculosis in kidney graft recipients have not been defined.
Material and Methods. This is a transversal analytical study. Every case of tuberculosis reported in patients receiving kidney grafts being treated in our hospital from 2002 to 2012 (General Regional Hospital 46, Mexican Institute of Social Security) were included. Confirmatory diagnosis of tuberculosis was achieved with positive growth culture. In order to identify risk factors, 250 patients with no prior history of tuberculosis were randomly chosen as control group. The following variables were assigned: Time elapsed between reception of graft and confirmed diagnosis of tuberculosis, clinical presentation of infection by M. tuberculosis, serum creatinine at the time of diagnosis of tuberculosis, the need to make modifications to the immunosuppressive treatment due to concomitant infections (cytomegalovirus, hepatitis B among others) and outcome; categorized as death, graft failure or loss, successful treatment or permanent kidney damage.
Results. In our population, tuberculosis prevalence was 1.4%. In neither of the groups history of tuberculosis was found. Average time in dialysis was 21.9 ± 15.4 y 12.3 ± 9.38 (p=0.48) in control group and tuberculosis respectively. Frequency and distribution of the types of donors showed no difference between groups (p=0.565): HLA antigens were 3.1 ± 2.24 and 4.4 ± 2.7 (p=0.377) respectively. The most frequent presentation of the disease was extra pulmonary; in 10 cases modifications to immunosuppressive treatment were required. In the tuberculosis group graft rejection was more frequent (p=0.005). No risk factors for developing TB were identified.
Conclusions. Prevalence reported in our population is similar to the one reported in developed countries. No risk factors for developing TB were identified in our groups.