Risk factors for post-transplant tuberculosis

George Tharayil John, Shankar Viswanathan, Abi Mookanottle Abraham, Uma Mukundan, Paulose Punnakuzhathil Thomas, Chakko Korula Jacob

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Background. Post-transplant tuberculosis (post-TxTB) occurs in 12 to 20% of patients in India and results in the death of 20 to 25% of those patients. Prospective studies on post-TxTB are few. Methods. Renal allograft recipients were studied prospectively for 3.1 (0 to 13.9) median (range) years for incidence, manifestations, risk factors, and prognosis for post-TxTB. Kaplan-Meier analysis was used to study the survival rates. The extended Cox proportional model for time-dependent covariates was used to measure the risk factors when the hazard was nonuniform. Results. Of the 1414 patients considered for inclusion, multiple-transplant subjects (N = 37) and patients who developed pre-transplant TB (pre-TxTB; N = 126) were excluded from the study. The prevalence of post-TxTB was 13.3% (N = 166). The risk of post-TxTB when on cyclosporine (CsA) therapy was 2.5 (P = 0.0311) and 1.9 (P = 0.0430) times at ≤6 and ≤12 months, respectively, compared with patients on prednisolone plus azathioprine (PRED + AZA). The risk of post-TxTB in the presence of diabetes mellitus, chronic liver disease, and other co-existing infections [including deep mycoses, cytomegalovirus (CMV), Pneumocystis carinii pneumonia (PCP), nocardia] was 2.2 (P = 0.0011), 1.7 (P = 0.0010) and 2.4 (P < 0.0001) times, respectively. Of the 166 patients with post-TxTB, 53 patients died, and of those deaths, 17 (32%) were due to post-TxTB; 11 (65%) of the 17 had co-existing infections. The factors associated with death were HLA mismatches, PRED + AZA immunosuppression, pre- and post-TxTB, diabetes mellitus, post-transplant diabetes (PTDM), and other co-existing infections. The extended Cox model for death as the outcome variable showed the following to be significant risk factors: post-TxTB >2 years (P = 0.0036), chronic liver disease >6 years (P = 0.0457), PTDM >5 years (P = 0.0729), diabetes mellitus (P = 0.0091), human lymphocyte antigen match ≤1 antigen (P = 0.0134), two to three antigens (P = 0.0448), and the presence of other co-existing infections (P < 0.0001). Conclusions. Cyclosporine therapy is associated with early post-TxTB. Diabetes mellitus and chronic liver disease are risk factors for post-TxTB. The occurrence of both pre-TxTB and post-TxTB (>2 years) along with hyperglycemia, liver disease, and other co-existing infections are important risk factors for death.

Original languageEnglish (US)
Pages (from-to)1148-1153
Number of pages6
JournalKidney International
Volume60
Issue number3
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Tuberculosis
Transplants
Coinfection
Liver Diseases
Antigens
Diabetes Mellitus
Chronic Disease
Nocardia
Pneumocystis Pneumonia
Mycoses
Azathioprine
Kaplan-Meier Estimate
Prednisolone
Cytomegalovirus
Proportional Hazards Models
Hyperglycemia
Cyclosporine
Allografts
India
Survival Rate

Keywords

  • Allograft and infection
  • Bacterial infection
  • India and TB
  • Infection
  • Renal transplantation
  • Tubercle bacillus

ASJC Scopus subject areas

  • Nephrology

Cite this

John, G. T., Viswanathan, S., Abraham, A. M., Mukundan, U., Thomas, P. P., & Jacob, C. K. (2001). Risk factors for post-transplant tuberculosis. Kidney International, 60(3), 1148-1153. https://doi.org/10.1046/j.1523-1755.2001.0600031148.x

Risk factors for post-transplant tuberculosis. / John, George Tharayil; Viswanathan, Shankar; Abraham, Abi Mookanottle; Mukundan, Uma; Thomas, Paulose Punnakuzhathil; Jacob, Chakko Korula.

In: Kidney International, Vol. 60, No. 3, 2001, p. 1148-1153.

Research output: Contribution to journalArticle

John, GT, Viswanathan, S, Abraham, AM, Mukundan, U, Thomas, PP & Jacob, CK 2001, 'Risk factors for post-transplant tuberculosis', Kidney International, vol. 60, no. 3, pp. 1148-1153. https://doi.org/10.1046/j.1523-1755.2001.0600031148.x
John, George Tharayil ; Viswanathan, Shankar ; Abraham, Abi Mookanottle ; Mukundan, Uma ; Thomas, Paulose Punnakuzhathil ; Jacob, Chakko Korula. / Risk factors for post-transplant tuberculosis. In: Kidney International. 2001 ; Vol. 60, No. 3. pp. 1148-1153.
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abstract = "Background. Post-transplant tuberculosis (post-TxTB) occurs in 12 to 20{\%} of patients in India and results in the death of 20 to 25{\%} of those patients. Prospective studies on post-TxTB are few. Methods. Renal allograft recipients were studied prospectively for 3.1 (0 to 13.9) median (range) years for incidence, manifestations, risk factors, and prognosis for post-TxTB. Kaplan-Meier analysis was used to study the survival rates. The extended Cox proportional model for time-dependent covariates was used to measure the risk factors when the hazard was nonuniform. Results. Of the 1414 patients considered for inclusion, multiple-transplant subjects (N = 37) and patients who developed pre-transplant TB (pre-TxTB; N = 126) were excluded from the study. The prevalence of post-TxTB was 13.3{\%} (N = 166). The risk of post-TxTB when on cyclosporine (CsA) therapy was 2.5 (P = 0.0311) and 1.9 (P = 0.0430) times at ≤6 and ≤12 months, respectively, compared with patients on prednisolone plus azathioprine (PRED + AZA). The risk of post-TxTB in the presence of diabetes mellitus, chronic liver disease, and other co-existing infections [including deep mycoses, cytomegalovirus (CMV), Pneumocystis carinii pneumonia (PCP), nocardia] was 2.2 (P = 0.0011), 1.7 (P = 0.0010) and 2.4 (P < 0.0001) times, respectively. Of the 166 patients with post-TxTB, 53 patients died, and of those deaths, 17 (32{\%}) were due to post-TxTB; 11 (65{\%}) of the 17 had co-existing infections. The factors associated with death were HLA mismatches, PRED + AZA immunosuppression, pre- and post-TxTB, diabetes mellitus, post-transplant diabetes (PTDM), and other co-existing infections. The extended Cox model for death as the outcome variable showed the following to be significant risk factors: post-TxTB >2 years (P = 0.0036), chronic liver disease >6 years (P = 0.0457), PTDM >5 years (P = 0.0729), diabetes mellitus (P = 0.0091), human lymphocyte antigen match ≤1 antigen (P = 0.0134), two to three antigens (P = 0.0448), and the presence of other co-existing infections (P < 0.0001). Conclusions. Cyclosporine therapy is associated with early post-TxTB. Diabetes mellitus and chronic liver disease are risk factors for post-TxTB. The occurrence of both pre-TxTB and post-TxTB (>2 years) along with hyperglycemia, liver disease, and other co-existing infections are important risk factors for death.",
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T1 - Risk factors for post-transplant tuberculosis

AU - John, George Tharayil

AU - Viswanathan, Shankar

AU - Abraham, Abi Mookanottle

AU - Mukundan, Uma

AU - Thomas, Paulose Punnakuzhathil

AU - Jacob, Chakko Korula

PY - 2001

Y1 - 2001

N2 - Background. Post-transplant tuberculosis (post-TxTB) occurs in 12 to 20% of patients in India and results in the death of 20 to 25% of those patients. Prospective studies on post-TxTB are few. Methods. Renal allograft recipients were studied prospectively for 3.1 (0 to 13.9) median (range) years for incidence, manifestations, risk factors, and prognosis for post-TxTB. Kaplan-Meier analysis was used to study the survival rates. The extended Cox proportional model for time-dependent covariates was used to measure the risk factors when the hazard was nonuniform. Results. Of the 1414 patients considered for inclusion, multiple-transplant subjects (N = 37) and patients who developed pre-transplant TB (pre-TxTB; N = 126) were excluded from the study. The prevalence of post-TxTB was 13.3% (N = 166). The risk of post-TxTB when on cyclosporine (CsA) therapy was 2.5 (P = 0.0311) and 1.9 (P = 0.0430) times at ≤6 and ≤12 months, respectively, compared with patients on prednisolone plus azathioprine (PRED + AZA). The risk of post-TxTB in the presence of diabetes mellitus, chronic liver disease, and other co-existing infections [including deep mycoses, cytomegalovirus (CMV), Pneumocystis carinii pneumonia (PCP), nocardia] was 2.2 (P = 0.0011), 1.7 (P = 0.0010) and 2.4 (P < 0.0001) times, respectively. Of the 166 patients with post-TxTB, 53 patients died, and of those deaths, 17 (32%) were due to post-TxTB; 11 (65%) of the 17 had co-existing infections. The factors associated with death were HLA mismatches, PRED + AZA immunosuppression, pre- and post-TxTB, diabetes mellitus, post-transplant diabetes (PTDM), and other co-existing infections. The extended Cox model for death as the outcome variable showed the following to be significant risk factors: post-TxTB >2 years (P = 0.0036), chronic liver disease >6 years (P = 0.0457), PTDM >5 years (P = 0.0729), diabetes mellitus (P = 0.0091), human lymphocyte antigen match ≤1 antigen (P = 0.0134), two to three antigens (P = 0.0448), and the presence of other co-existing infections (P < 0.0001). Conclusions. Cyclosporine therapy is associated with early post-TxTB. Diabetes mellitus and chronic liver disease are risk factors for post-TxTB. The occurrence of both pre-TxTB and post-TxTB (>2 years) along with hyperglycemia, liver disease, and other co-existing infections are important risk factors for death.

AB - Background. Post-transplant tuberculosis (post-TxTB) occurs in 12 to 20% of patients in India and results in the death of 20 to 25% of those patients. Prospective studies on post-TxTB are few. Methods. Renal allograft recipients were studied prospectively for 3.1 (0 to 13.9) median (range) years for incidence, manifestations, risk factors, and prognosis for post-TxTB. Kaplan-Meier analysis was used to study the survival rates. The extended Cox proportional model for time-dependent covariates was used to measure the risk factors when the hazard was nonuniform. Results. Of the 1414 patients considered for inclusion, multiple-transplant subjects (N = 37) and patients who developed pre-transplant TB (pre-TxTB; N = 126) were excluded from the study. The prevalence of post-TxTB was 13.3% (N = 166). The risk of post-TxTB when on cyclosporine (CsA) therapy was 2.5 (P = 0.0311) and 1.9 (P = 0.0430) times at ≤6 and ≤12 months, respectively, compared with patients on prednisolone plus azathioprine (PRED + AZA). The risk of post-TxTB in the presence of diabetes mellitus, chronic liver disease, and other co-existing infections [including deep mycoses, cytomegalovirus (CMV), Pneumocystis carinii pneumonia (PCP), nocardia] was 2.2 (P = 0.0011), 1.7 (P = 0.0010) and 2.4 (P < 0.0001) times, respectively. Of the 166 patients with post-TxTB, 53 patients died, and of those deaths, 17 (32%) were due to post-TxTB; 11 (65%) of the 17 had co-existing infections. The factors associated with death were HLA mismatches, PRED + AZA immunosuppression, pre- and post-TxTB, diabetes mellitus, post-transplant diabetes (PTDM), and other co-existing infections. The extended Cox model for death as the outcome variable showed the following to be significant risk factors: post-TxTB >2 years (P = 0.0036), chronic liver disease >6 years (P = 0.0457), PTDM >5 years (P = 0.0729), diabetes mellitus (P = 0.0091), human lymphocyte antigen match ≤1 antigen (P = 0.0134), two to three antigens (P = 0.0448), and the presence of other co-existing infections (P < 0.0001). Conclusions. Cyclosporine therapy is associated with early post-TxTB. Diabetes mellitus and chronic liver disease are risk factors for post-TxTB. The occurrence of both pre-TxTB and post-TxTB (>2 years) along with hyperglycemia, liver disease, and other co-existing infections are important risk factors for death.

KW - Allograft and infection

KW - Bacterial infection

KW - India and TB

KW - Infection

KW - Renal transplantation

KW - Tubercle bacillus

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