Tuberculosis is not an obstacle to kidney transplantation

Background. Monitoring patients with chronic kidney disease during preparation for kidney transplantation, in the immediate postoperative period and then over the years is a unique opportunity to verify the effectiveness of anti-tuberculosis therapy.

The aim. To analyse the results of long-term observation of patients with chronic kidney disease stage 5 (CKD stage 5), who received a course of anti-tuberculosis therapy before kidney transplantation.

Materials and methods. The analysis of the results of long-term observation of 7 patients with CKD stage 5 who had tuberculosis (TB) while receiving renal replacement therapy (RRT) using the method of programmed hemodialysis and continued observation by a phthisiatrician at the stages of preparation for kidney transplantation and for a year after, was carried out.

Results. At the time of tuberculosis diagnosis, the observed multicomorbid patients had been on programmed hemodialysis for an average of 2.9 years. Anti-tuberculosis therapy was administered according to individualized regimens. The average waiting period for kidney transplantation for these patients was 3.6 years. Kidney transplantation was performed successfully in all 7 observed patients, after that all patients received three-component immunosuppressive therapy (tacrolimus, mycophenolate mofetil, methylprednisolone). Control examination to exclude reactivation of tuberculosis was carried out once every 6 months on a planned basis or upon complaints. The average follow-up period for recipients was 3.9 years. Reactivation of tuberculosis after kidney transplantation was recorded in only one patient. Thus, in 6/7 (85.7 %) patients with CKD with tuberculosis infection, kidney transplantation and administration of immunosuppressive therapy were performed without reactivation of tuberculosis.

Conclusions. The long-term absence of tuberculosis reactivation in the majority of patients (85.7 %) against the background of not only renal failure, but also immunosuppressive therapy after kidney transplantation was achieved through an individual approach to the treatment and management of each patient with CKD and interdisciplinary interaction of doctors.

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