CLINICAL PROFILE, RISK FACTOR, DIAGNOSIS, TREATMENT AND OUTCOME OF POST RENAL TRANSPLANT TUBERCULOSIS FROM A SINGLE CENTRE.

K GUPTA1, S BAGAI2, A SHARMA1
1Postgraduate Institute of Medical Education and Research , Chandigarh, India, 2Max Superspeciality hospital, Saket, New Delhi, India

Background: Tuberculosis (TB) is also one of the predominant opportunistic infections post transplant.
Aims: To study the risk factors, clinical profile, treatment and outcome in post transplant TB.
Methods: Post renal transplant recipients from January 2014 and June 2017 with TB were enrolled and followed up.
Results: Sixty recipients were diagnosed with TB. Mean age was 37.97 years and mean duration of diagnosis post transplant was 44.02 months. Fever (86.7%) followed by weight loss (63%), cough with expectoration (31.7%) and breathlessness (10%) were common presentations. Extra-pulmonary 35 (58.3%) and disseminated TB 12 (20%) were more common than pulmonary TB 35 (58.3%).AFB positivity in sputum and BAL was seen in 3 (5%) and 16 (26.7%) patients whereas Trans-bronchial lung biopsy confirmed diagnosis in 6 (10 %) patients.
Lymphadenitis, 12 (20%) followed by gastrointestinal TB 8 (13.3%), pleural TB 6 (10%), spinal TB 3 (5%), TB Pericarditis 2(3.3%), CNS TB 2(3.3%), cold abscess 2(3.3%), TB osteomyelitis 1(1.6%), TB tenosynovitis 1 (1.6%) and Genitourinary TB 1 (1.6%) were pattern of involvement in extra-pulmonary TB.
Prior rejection 11 (18.3%), Anti-thymocyte Globulin use 10(16.6%), post transplant diabetes mellitus 7(11.6%), CMV 5(8.3%), HCV 4(6.6%) and HIV infection 1(1.67%) were common risk factors.
Most patients were treated for 12-18 months with non rifampicin based Antitubercular (ATT) drugs. Four (8.3%) patients had ATT induced hepatitis. 3 patients died, 2 (3%) had graft loss and 2 patients had further episodes of tuberculosis.
Conclusion: Tuberculosis is a very common opportunistic infection in post renal transplant setting in India. High index of suspicion is required for methodological work up and diagnosis.
Keywords: Tuberculosis , Extrapulmonary, Non Rifampicin Anti Tubercular Drugs.


Biography:
Dr K L Gupta is Professor of Nephrology and Head of Department at The prestigious Postgraduate Institute of Medical Education and Research at Chandigarh India. He has been serving as the faculty member since 1983. His Mai areas of interest include Fungal Infections following Renal translation as well as angio-invasive Fungal Infections of the native kidneys and Lupus Nephritis. He has been awarded many fellowship including FASN, FRCP (London) , FAMS, FISOT, FISN etc. He is currently the President of the Indian Society of Organ Transplantation and President of the Nephrology, Urology and Transplantation Society of SAARC Countries.

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