Tuberculosis in kidney transplant recipients: A case series

Table 1 Baseline characteristics of patients

	Patient 1	Patient 2	Patient 3	Patient 4
Age (yr)	63	67	38	67
Ethnicity	Vietnamese	Caucasian	Indonesia	Caucasian
Sex	Male	Male	Female	Male
BMI (kg/m2)	32	33	21	32
Prior TB exposure	Incarceration in Vietnam	Vietnam war veteran	Lived in Indonesia till age 25	None
PPD/IGRA	Positive	Not done	Positive	Negative
Pre-transplant CXR	Non-calcified lymph nodes	Prior granulomatous disease	Normal	Calcified lung nodules
Smoking	Yes	No	No	No
Diabetes mellitus	Yes	No	No	Yes
Hepatitis C	No	No	No	No
Chronic liver disease	Prior hepatitis B exposure	No	No	No
Pre-transplant INH prophylaxis	No	No	No	No

BMI: Body mass index; TB: Tuberculosis; PPD: Purified protein derivative; IGRA: Interferon gamma release assay; CXR: Chest X-ray; INH: Isoniazid.

Table 2 Post-transplant patient characteristics and outcomes

	Patient 1	Patient 2	Patient 3	Patient 4
INH prophylaxis	No	No	Yes	No
T cell depleting antibody	Yes	Yes	Yes	Yes
Immunosuppressive	Tacrolimus, MMF	Tacrolimus, MMF	Tacrolimus, MMF	Tacrolimus, MMF
Corticosteroid	No	Yes	Yes	Yes
Acute rejection (6 mo prior to TB diagnosis)	No	No	No	No
Clinical features	Fever, palpitations, cervical LN	Fever, shortness of breath, cough	Fever, acute kidney injury	Fever, shortness of breath, leg swelling
TB site	Disseminated	Pulmonary	Extra-pulmonary	Disseminated
Time to symptom onset (mo)	11.5	2	9	2
Time to diagnosis, post-transplant (mo)	12	3	11	3
Treatment regimen	RIPE	None	RIPE-M	RIPE-M, Amikacin
Treatment duration (mo)	6.5	N/A	6	7
Adverse drug reaction	Hepatotoxicity	N/A	None	Neurologica,vision loss
Other complication	HBV reactivation, acute liver injury	Septic shock, MAS	None	VTE, IRIS, allograft failure
Outcome	Cured	Death	Cured	Death

INH: Isoniazid; MMF: Mycophenolate mofetil; TB: Tuberculosis; LN: Lymphadenopathy; RIPE: Rifampin, isoniazid, pyrazinamide, ethambutol; RIPE-M: Rifampin, isoniazid, pyrazinamide, ethambutol, moxifloxacin; HBV: Hepatitis B virus; MAS: Macrophage activation syndrome; VTE: Venous thromboembolism; IRIS: Immune reconstitution inflammatory syndrome.