Tuberculosis in renal transplant patient - Experience in Bangladesh

Tuberculosis in renal transplantation is commonly encountered in developing nations. The prevalence is 10-15 times higher than normal population. 19 cases of Tuberculosis were detected among 317 transplant patients over a period of 10 years (range 27-58 yrs; M-11, F-8). The clinical features were fever (73%), weight loss (42%), Cough (42%), Pleural effusion (21%), Ascitis (15%), Haemoptysis (10%), and Lymphadenopathy (10%). PPD skin test, isolation of AFB from sputum, Ascitic Fluid and pleural fluid were noncontributory. 8 patients (42%) presented with evidence of pulmonary tuberculosis, whereas 11(57%) were extrapulmonary. Among the extrapulmonary involvement, lymphadenopathy in 2 cases, pleural effusion in 4 cases and peritonitis in 2 cases. Sputum for AFB were isolated in 4, out Of 8 cases of pulmonary tuberculosis but none from pleural fluid and ascitic fluid. However histological confirmation were made in 4 cases of extrapulmonary tuberculosis. All patients were treated with INH 300 mg daily. Rifampicin 450-600 mg and either Ethambutol 12-15 mg/kg body weight daily or pyrazinamide 25-35mg/kg. None of the patients were receiving cyclosporine. Prednisolone dose was increased from 10-20 mg for first 6 months. 70% patients were reported to be improved, one died and 5 others not reported for follow up. Treatment continued for 3 months with 3 drugs when ethambutol or pyrazinamide withdrawn and then other two drugs continued for 9 months. However, after 9 months Rifampicin was withdrawn and INH continued for 5 years. In conclusion, tuberculosis appears to be 6 times more common in our patients and prognosis is satisfactory with appropriate treatment.