Tuberculosis Outcome in Solid Organ Transplant Recipients

Reem S Almaghrabi; Reem Alameer; Nada Alshehri; Abdullah Almohaizeie; Abdulrahman A Alrajhi; Ali S Omrani

Tuberculosis Outcome in Solid Organ Transplant Recipients

Objectives:

Limited data are available on tuberculosis outcome after solid organ transplantation in the Middle East. Between 2005 and 2016, tuberculosis was diagnosed in 42 (1.4%) out of 3,042 kidney, liver or heart transplant recipients. Therefore, we aimed to describe the epidemiology, clinical characteristics, treatment and outcome of TB in the setting of SOT in one of the largest transplant centers in the Middle East and North Africa region.

Material and Methods:

Details of kidney, liver or heart transplant recipients were retrospectively retrieved from the electronic database of the Organ Transplant Center at King Faisal Specialist Hospital and Research Centre, Riyadh. Active tuberculosis was defined as cases treated for tuberculosis based on microbiological results, radiological and/or clinical features suggestive of tuberculosis.

Results:

Median age was 54.5 years (range 20–67) and 81% were males, and median time from transplant to tuberculosis was 14.6 months (0.5–255.8). Thirteen (31.0%) were recipients of organs from deceased donors. Fever (71.4%) and weight loss (57.1%) were the commonest presenting symptoms. In 26 patients (61.9%) rifampin and/or pyrazinamide were substituted with moxifloxacin. Hepatotoxicity-related treatment interruption occurred in 13 (31.0%) patients. Overall mortality was noted in Six (14.3%) patients within 12 months of tuberculosis diagnosis (none were tuberculosis related). Age (adjusted OR 0.892, 95% CI 0.827–0.961; P 0.003) and Charlson Comorbidity Score (adjusted OR 2.866, 95% CI 1.331–6.174; P 0.007) were independently associated with all-cause mortality at 12-months. Overall, mortality was higher in liver (25.0%) compared with kidney (9.1%) and heart transplant recipients (0%), but the difference was not statistically significant (log rank P 0.51).

Conclusions:

Moxifloxacin-based anti-tuberculous therapy in post-SOT tuberculosis is associated with low rates of hepatotoxicity interruptions: low mortality and no graft rejection.