Tuberculosis in kidney transplant candidates and recipients

Table 1 Risk factors for tuberculosis in transplant candidates and recipients

Risk factors in transplant candidates	Risk factors in transplant recipients
Presence of comorbidities: Diabetes mellitus, COPD	Donor-derived tuberculosis
Smoking	Co-existing infections: COVID-19, HIV, Nocardiosis, Pneumocystis jirovecii, CMV
Transplant candidate age: Young and Elderly	Induction: Anti-T-lymphocyte antibodies or OKT3
Immunomodulatory states: Chronic HCV infection, CMV infection	Maintenance immunosuppression: Antiproliferative agents (MMF); Prednisolone-Azathioprine; immunosuppression; Everolimus
Chronic liver disease	Graft rejection: Intensification of immunosuppression
Dialysis vintage	Genetic factors: HLA A68(28)/A69(28) locus (in Indian sub-population)
Previous history of tuberculosis or TBI: Positive tuberculin test or chest X-ray; suggestive of previous infection	—
Family history of tuberculosis	—
Other co-existing infections: COVID19, HIV	—

—: No data. CMV: Cytomegalovirus; COPD: Chronic obstructive pulmonary disease; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; HLA: Human leucocyte antigen; MMF: Mycophenolate mofetil; OKT3: Orthoclone muromonab CD3; TBI: Tuberculosis infection.

Table 2 Dose of antitubercular therapy drugs based on estimated glomerular filtration rate in mL/min/1.73m²

Drug	eGFR > 60	eGFR 30-60	10-30	< 10	Maintenance hemodialysis
Isoniazid1	5 mg/kg/day	No dose adjustment	No dose adjustment	No dose adjustment	No dose adjustment
Rifampicin1	10 mg/kg/day	No dose adjustment	No dose adjustment	No dose adjustment	No dose adjustment
Pyrazinamide2	25 mg/kg/day	No dose adjustment	25 mg/kg/dose every 48 h	25 mg/kg/dose three times/week	25 mg/kg/dose three times/week
Ethambutol3	15 mg/kg/day	No dose adjustment is required	15 mg/kg/day every 48 h	15 mg/kg/day every 48 h	15 mg/kg 3 times/week after dialysis sessions
Streptomycin	15 mg/kg/day	15 mg/kg individual doses with intervals between doses adjusted to achieve undetectable plasma trough levels
Levofloxacin	750-1000 mg/day	750-1000 mg 3 times/week	750-1000 mg 3 times/week	750-1000 mg 3 times/week	750-1000 mg 3 times/week
Moxifloxacin4	400 mg/day	400 mg/day	400 mg/day	400 mg/day	400 mg/day

¹Isoniazid and rifampicin may be given intravenously where absorption is compromised (not available in all countries).

²Check uric acid and monitor for gout.

³In patients on ethambutol, check baseline color vision and visual acuity and warn patients to report any changes in red/green discrimination or visual acuity. Check peak and trough levels (if available).

⁴Moxifloxacin may be preferred in severe renal impairment- monitor for neurotoxicity and tendinopathies especially when used with steroids. eGFR: Estimated glomerular filtration rate.