Clinical study on infections with special reference to tubercular infection in post-kidney transplant recipients from Western India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20263500Keywords:
Graft dysfunction, Infection, Kidney transplantation, Mortality, Renal allograft, TuberculosisAbstract
Background: Infections remain a major cause of morbidity and mortality following kidney transplantation. The spectrum of infectious complications differs between developing and developed countries, with tuberculosis (TB) continuing to pose a significant challenge in endemic regions such as India. Data on post-transplant infections from western India are limited. Objectives were to evaluate the spectrum of infections, with special reference to tuberculosis, among kidney transplant recipients and assess their impact on graft and patient outcomes.
Methods: This retrospective and prospective observational study was conducted at the department of nephrology, Goa Medical College, Goa, India. Sixty-two kidney transplant recipients transplanted between August 2018 and August 2025 were included. Demographic, transplant-related, infectious, tuberculosis-related, graft, and patient outcome data were analyzed. Risk factors for post-transplant tuberculosis were assessed using univariate analysis.
Results: Of 62 recipients, 48 (77.4%) developed at least one infectious episode, accounting for 84 infectious events. Urinary tract infection was the most common infection (32.1%), followed by lower respiratory tract infection (26.2%) and tuberculosis (10.7%). Tuberculosis occurred in 9 recipients (14.5%), with extrapulmonary disease predominating (55.6%). Two-thirds of cases developed within two years of transplantation. Low socioeconomic status (OR 18.67, p=0.002) and chronic allograft nephropathy (OR 4.74, p=0.04) were significantly associated with post-transplant tuberculosis. Chronic graft dysfunction occurred in 30.6% and overall mortality was 29%. Mortality among tuberculosis patients was 88.9%.
Conclusions: Infectious complications remain highly prevalent after kidney transplantation in western India. Tuberculosis continues to be associated with substantial graft dysfunction and mortality, highlighting the need for early diagnosis, vigilant surveillance, and prompt management.
References
Kidney Disease: improving global outcomes KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9(Suppl 3):S1-S155.
Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601-14.
Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338(24):1741-51.
Kotton CN. CMV: prevention, diagnosis and therapy. Am J Transplant. 2013;13(Suppl 3):24-40.
Subramanian AK, Morris MI. Mycobacterium tuberculosis infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):68-76.
Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients. Clin Infect Dis. 1998;27(5):1266-77.
John GT, Shankar V, Abraham AM, Mukundan U, Thomas PP, Jacob CK. Risk factors for post-transplant tuberculosis. Kidney Int. 2001;60(3):1148-53.
Sakhuja V, Jha V, Varma PP, Joshi K, Gupta KL, Sud K, et al. Tuberculosis in kidney transplant recipients in India. Transplantation. 1996;61(2):211-5.
Sorohan BM, Ismail G, Tacu D, Obrișcă B, Ciolan G, Gîngu C, et al. Mycobacterium Tuberculosis Infection after Kidney Transplantation: A Comprehensive Review. Pathogens. 2022 Sep 13;11(9):1041.
Aguado JM, Torre-Cisneros J, Fortun J, Benito N, Meije Y, Doblas A, et al. Tuberculosis in solid-organ transplant recipients. Clin Microbiol Infect. 2009;15(7):671-82.
World Health Organization. Global tuberculosis report 2024. Geneva: WHO; 2024.
Sharma SK, Mohan A. Tuberculosis: from an incurable scourge to a curable disease. J Assoc Phys India. 2018;66(3):12-8.
Prasad P, Sharma S, Mohanasundaram S, Agarwal A, Verma H. Tuberculosis in kidney transplant candidates and recipients. World J Transplant. 2024;14(3):96225.
Parasuraman R, Julian K. Urinary tract infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):327-36.
Origüen J, Fernández-Ruiz M, López-Medrano F, Ruiz-Merlo T, González E, Morales JM, et al. Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options. Transpl Infect Dis. 2016;18(4):575-84.
Ariza-Heredia EJ, Beam EN, Lesnick TG, Cosio FG, Kremers WK, Razonable RR. Impact of urinary tract infection on allograft function after kidney transplantation. Clin Transplant. 2014;28(6):683-90.
Abbott KC, Swanson SJ, Richter ER, Bohen EM, Agodoa LY, Peters TG, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 2004;44(2):353-62.
Razonable RR, Humar A. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):93-106.
Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102(6):900-31.
Vishnu DS, Tilve P, Bodke SY, Deb S, Andankar M, Oza U, et al. Infection Patterns and Survival Among Renal Transplant Recipients. Indian J Nephrol. 2025;35(4):490-6.
Kumar A, Agarwal C, Hooda AK, Ojha A, Dhillon M, Hari Kumar KV. Profile of infections in renal transplant recipients from India. J Family Med Prim Care. 2016;5(3):611-4.
Dharnidharka VR, Agodoa LY, Abbott KC. Effects of infectious complications on graft survival. Transplantation. 2007;84(10):1231-8.
Kumar D, Humar A. Respiratory viral infections in transplant recipients. Am J Transplant. 2005;5(8):188-95.
Sharma A, Sharma SK. Management of tuberculosis in renal transplant recipients. Indian J Nephrol. 2021;31(4):299-307.
Indian Council of Medical Research. National Tuberculosis Elimination Programme Technical Guidelines. New Delhi: ICMR; 2023.
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Copyright (c) 2026 Sumit Tyagi, Jai prakash Tiwari, Hasil Mohammed Ali Edakkunnummel, Mudasir Habib, Bipasa Kar, Joseema Colaco, Tejaswini Bhatlawande
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