Pretransplant Antitubercular Therapy how long?

ABSTRACT

To define a safe duration of antitubercular therapy in patients on dialysis awaiting a kidney transplant. Patients with chronic renal failure are more prone to develop tuberculosis than the general population. Continuing dialysis till completion of antitubercular therapy [ATT] has its problems both in terms of morbidity and finances. Since most patients in developing countries have to pay for their dialysis, it is transplantation which balances the risk of flare up of tuberculosis important to define a safe duration of ATT prior to renal with the problems of prolonged dialysis. Retrospective. Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India. Materials and methods: Records of 1360 patients who had received renal allograft at our hospital were reviewed retrospectively. Patients who were found to have tuberculosis prior to transplantation and received therapy according to our hospital protocol were assessed for the duration of pre transplant ATT and their outcome after transplantation. Out of 96 patients who received ATT starting at a mean of 122 +/- 82 days before transplant, only one developed tuberculosis in the post transplant period. Of the 96 patients, a subgroup of 23 patients had received an allograft between six to eight weeks after initiating ATT, that. At a mean follow up of 29 months post transplant, none of these while the rest were transplanted at varying periods after23 patients developed recurrence of tuberculosis. This compares favorably with a 13.3% incidence of post transplant tuberculosis among those patients who did not have the disease preoperatively. Renal transplantation after 6-8 weeks of ATT is probably associated with a minimal risk of flare up of the disease in the post transplant period