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Tuberculosis (TB) is an endemic disease in Argentina, with an incidence rate of 25.9 cases/100,000 inhabitants. Several studies report that kidney transplant (KT) recipients have 20 to 100 times higher risk of developing TB than the general population.
Objectives
1) To describe in a cohort of pediatric kidney transplant patients the cumulative incidence and incidence rate of TB, overall and in 2 periods: 1988-2000 (era1); 2001-2023 (era2); (From 2001, all rejection episodes were biopsy confirmed), time of appearance, and clinical characteristics. 2) To compare patient and graft survival in those with and without TB.
Observational, descriptive, retrospective study. Data were collected from medical records of all KT patients at Hospital J.P Garrahan, from December 12th, 1988 to October 30th, 2023 and from SINTRA registry.
Between December 15th, 1988 and October 30th, 2023, 1,075 children received a KT. TB was diagnosed in 13 of them. The cumulative incidence (CI) of TB during the entire follow-up was 1.21%, and the incidence rate was 1.2 episodes/100 patients/year (95% CI interval: 1.11-1.27). In era 1 the CI was 1.28%, and in era 2 it was 1,12% (p=0.89). Demographic data are shown in Table 1. The average time from transplant to diagnosis of TB was 53 months; only 1 patient was diagnosed with TB at the tenth month after transplant.
Pulmonary tuberculosis was the most frequent clinical manifestation (n=9), only one patient presented with isolated involvement of the skin. Two patients presented extrapulmonary manifestations: brain granuloma and chorioretinitis in one case, and intestinal involvement in the other. Symptoms were: fever (92%), weight loss (30.8%), asthenia (46.2%) and respiratory symptoms (76.9%).
The diagnosis was based on a positive microbiological culture; 12 patients received rifampicin (rifampicin sensitive) and one to levofloxacin (rifampicin resistant); 84% received treatment with 4 drugs (isoniazid, rifampicin, pyrazinamide and ethambutol). Median time of follow-up was 6.3 years (IQR: 4.6-11.8). No deaths, graft loss or rejection episodes were reported at this period. There were no significant differences neither in graft nor on patient survival between those with and without TB (p=0.44) and p=(0.74) respectively.
The cumulative incidence in kidney transplant patients was higher than in the general population, similar to other published studies. Pulmonary tuberculosis was the most frequent clinical manifestation. There were no complications related to the kidney graft.
Suspicion, early diagnosis, close follow-up, as well as contact study are a priority to avoid the spread of TB and ensure favorable results in this population.