LAUSR

Renal transplant recipients are at increased risk of tuberculosis (TB) than the general population especially in endemic areas. Post-transplant tuberculosis poses challenges to the physician both for diagnosis and treatment. There are no solid data regarding occurrence of renal allograft tuberculosis in this population. Here we report a case series of renal allograft recipients with occurrence of renal allograft tuberculosis. We analyzed data of 610 patients who underwent renal transplantation in our center between 2006 to 2019. Clinical details were retrospectively analyzed from Hospital Information System (HIS). Out of 610 transplant recipients, four (0.65%) were found to have renal allograft TB. One of the donors had a history of pulmonary tuberculosis which was treated. Among the recipients, one had history of disseminated TB 2 years prior to transplantation. Only one patient received induction immunosuppression with lymphocyte depleting agent. All of them received triple immunosuppression with tacrolimus, mycophenolate and prednisolone. None of them received isoniazid/rifampicin prophylaxis. The shortest time interval to the occurrence of allograft tuberculosis was 2 months (donor had history of tuberculosis). The longest was 78 months. All patients presented with fever and allograft dysfunction. Three out of 4 patients had biopsy showing granulomatous interstitial nephritis with urine culture for Mycobacterium tuberculosis positive. One of them had PUJ obstruction due to tuberculosis for which Boari flap vesicocalicostomy was done. One patient had perigraft collection, drainage of which showed Acid Fast Bacilli (AFB) and culture positivity for mycobacterium tuberculosis. The immunosuppression was not reduced for any of them and all were treated with non Rifampicin containing anti-tuberculosis treatment (ATT) regime for 9 months to 1 year. All patients had good response and complete remission. There was no mortality related to allograft tuberculosis. All the patients had their renal function back to baseline at the end of treatment. Graft tuberculosis may present as fever as allograft dysfunction. The treatment with Anti tuberculosis drugs is effective in achieving complete cure and restoring the graft function.