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• W3154198342 abstract "Tuberculosis (TB) remains a major challenge in transplant patients particularly in endemic countries with frequent loss of transplanted kidneys. Importantly, many of the features for TB, specifically in the paediatric post-kidney transplant population, have not yet been adequately defined. The aim of the study was to describe the incidence, clinical presentation and outcomes in our paediatric kidney transplant recipients. This was a retrospective descriptive study of 212 paediatric kidney transplant recipients at Red Cross War Memorial Children`s Hospital from 1995 to 2019. Among the 212 kidney transplant patients, 20 (9%) were diagnosed with tuberculosis (TB) of which two thirds (n=13) were diagnosed during the first two years post-transplant. TB was confirmed bacteriologically in 12 (60%) children, and the remaining 8(40%) were clinically diagnosed. The main presenting symptoms were fever (n=13, 65%), weight loss (n=12, 60%) and cough (n=10, 50%). Acute rejection of the transplanted kidney was confirmed at diagnosis in nine children. Immunosuppression had been intensified with pulsed intravenous steroids for a rejection episode within the 3 months before the diagnosis of tuberculosis in 8 (40%) children. Tuberculin skin test was done in all children and was positive in 4 (20%) whilst chest radiography showed abnormalities suggestive of TB in 16 (80%) children. Among the children with TB, 15 (75%) were pulmonary, five (25%) extra-pulmonary among whom three with the TB foci in the allograft. A coinfection with Ebstein Barr virus was found in three cases, Cytomegalovirus in two children and Staphylococcus in another two children. Due to drug interactions, up to three fold increase in cyclosporine or tacrolimus dose was required to maintain therapeutic blood levels which was regularly monitored in the weeks after commencing TB treatment. Isoniazid (INH) prophylaxis appeared protective against development of TB (p=0.04). Other factors such as gender (p=0.25), age group above 15 years (p=0.59) ,10-14 years(p= 0.76), 5-9 years (p=0.81), and type of allograft (p= 0.73) were not significant risk factors for developing TB post kidney transplantation. All the TB infections were successfully treated with a graft and patient survival of 100%. Kidney transplant recipients have a high risk of TB. Chest radiography is a sensitive TB screening tool. A high index of suspicion is required due to its atypical presentation in these patients and frequent association with other infections. Frequent and meticulous monitoring of immunosuppression drug levels during treatment of TB is required to avoid loss of patient or graft. Isoniazid prophylaxis protects against development of TB in this population." @default.
• W3154198342 created "2021-04-26" @default.
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• W3154198342 date "2021-04-01" @default.
• W3154198342 modified "2023-09-23" @default.
• W3154198342 title "POS-748 TUBERCULOSIS IN PAEDIATRIC KIDNEY TRANSPLANT RECIPIENTS – A SINGLE CENTRE EXPERIENCE." @default.
• W3154198342 doi "https://doi.org/10.1016/j.ekir.2021.03.780" @default.
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