A UK centre based review of tuberculosis post kidney transplantation

The incidence of active tuberculosis (TB) post renal transplantation is much higher than the general population. This has previously been described as presenting in the first year following solid organ transplantation and is predominantly due to disease reactivation. Diagnosis can be challenging in this patient group who may present with atypical presentations or extra-pulmonary infection. In a London based renal transplant centre, retrospective data was collected including demographic data, site of disease and culture positivity. Electronic patient records and our TB database was analysed for case details for rates of active TB. A total of 2199 patients received renal transplantation between November 2005 to December 2018 of which, 8 patients were treated for active TB. Of these patients the median time to TB diagnosis was 4.35 years (IQR 1.125-6.2). None were screened for latent TB but 4 were on prophylactic isoniazid 150mg od at the time of diagnosis; of which 2 developed isoniazid resistant disease. A total of 3 cases were culture confirmed. 6/8 cases were extrapulmonary TB. There was 1 graft rejection and 2 graft losses. In our cohort, the rate of TB remains comparable to historic data however the time to diagnosis was longer than expected, suggesting possible re-exposure. Within our patients who received chemoprophylaxis, there was a high rate of isoniazid resistance and hence isoniazid use and a higher dose needs to be considered.