Analysis of the clinical characteristics of patients who developed tuberculosis after renal transplantation

Background The early clinical diagnosis of tuberculosis (TB) in kidney transplant recipients is difficult, and TB is a major factor contributing to transplant failure and mortality in these patients. This study is to analyze the characteristics of patients who developed TB after renal transplantation in an effort to improve the diagnosis and treatment of such patients. Methods This retrospective study examined 100 patients who received kidney transplants and subsequently developed TB, and were then treated at the Hunan Chest Hospital from January 2014 to January 2024. The clinical characteristics of patients were examined, including general condition, time of TB onset, clinical manifestations, site of TB, immunological indicators, method of etiological detection, imaging findings, treatment, and outcome. Results Secondary pulmonary TB was the most common diagnosis overall (n = 76), and abdominal TB was the most common type of extrapulmonary TB (n = 8). Eighty-eight patients were tested by the interferon-gamma release assay (IGRA); 72 (81.8%) had positive results, 13 (14.8%) had negative results, and 3 (3.4%) had uncertain results. Twenty-six patients received the tuberculin skin test (TST); 7 (26.9%) had positive results and 19 (73.1%) had negative results. The overall etiological detection rate was 58.0%. Analysis of factors affecting outcome showed that patients who received an isoniazid + rifamycin + ethambutol + moxifloxacin regimen were more likely to achieve cure than those treated with an isoniazid + rifamycin + ethambutol + pyrazinamide regimen ( P  < 0.05). Conclusions Patients who develop TB after renal transplantation have atypical symptoms and imaging findings. In addition to conventional detection methods, the IGRA, TST, and biopsy may aid in diagnosis. The anti-TB regimen of isoniazid + rifamycin + ethambutol + moxifloxacin appeared to provide a better outcome in this group of patients.