Nocardiosis in tropical renal transplant recipients

Background: The epidemiology of nocardiosis in the tropics among renal transplant recipients has not been reported. Methods: An evaluation of nocardiosis for 30 yr in one of the large transplant centres in South Asian region. Results: Of the 1968 patients who received primary renal allografts at Christian Medical College & Hospital, 27 patients developed nocardiosis over 30 yr. Early nocardiosis (≤ 2 yr) was associated with chronic liver disease and the use of cyclosporin (CsA) as compared with its later occurrence (> 2 yr). Seventeen patients (63 %) had two or more associated post-transplant infections, of whom 10 had tuberculosis. Mortality in these patients was associated with chronic liver disease. Conclusions: Nocardiosis manifests earlier (< 2 yr) in CsA treated patients who have chronic liver disease. Among renal transplant recipients of the tropics nocardiosis is a marker of a highsusceptibility to tuberculosis and other infections, the association with tuberculosis is stronger in those developing early nocardiosis (< 2 yr). Chronic liver disease is a risk factor for death in patients with nocardiosis especially when associated with tuberculosis. This report constitutes the largest single centre experience among renal transplant recipients.