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Hospital do Rim e Hipertensão

TRANSMISSION OF TUBERCULOSIS BY KIDNEY DONATION Vanessa dos Santos Silva , Isis de Figueiredo Alfredo Guimarães, Ana Paula Maia Baptista, Marina Pontello Cristelli, Tainá Veras de Sandes-Freitas, Marcello Franco, Hélio Tedesco-Silva Junior, José Osmar Medina-Pestana

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Hospital do Rim e Hipertensão

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  1. TRANSMISSION OF TUBERCULOSIS BY KIDNEY DONATIONVanessa dos Santos Silva, Isis de Figueiredo Alfredo Guimarães, Ana Paula Maia Baptista, Marina Pontello Cristelli, Tainá Veras de Sandes-Freitas, Marcello Franco, Hélio Tedesco-Silva Junior, José Osmar Medina-Pestana Hospital do Rim e Hipertensão-Fundação Oswaldo Ramos Universidade Federal de São Paulo Disciplina de Nefrologia São Paulo Brasil Hospital do Rim e Hipertensão

  2. Introduction • The incidence of tuberculosis among kidney transplant patients is about 0.35 to 15% worldwide and around 1.71% in Brazil. •  The risk of TB in renal transplant patients is 20 to 30 times greater than in the general population, the implication being high morbimortality.* • The tuberculosis reactivation after transplantion is the most common presentation among transplant recipients, but transmission through the transplanted allograft has been reported in up to 4% of cases.** *. Currie, Andrew C. and cols. Transplantation. 2010 Oct 15;90(7):695-704. ** Singh,N. and cols. Clinical Infectious Deseases. 1998 Nov;27(5):1266-77 Hospital do Rim e Hipertensão

  3. Objective • Report two cases of probable transmission of tuberculosis by kidney transplantation Hospital do Rim e Hipertensão

  4. Case Report Donor: -17 years, -Meningococcal meningitis, HIV negative -Has evolved to brain death after 23 days of hospitalization.  -He had persistent fever despite antibiotic therapy. -There was no history of illness or contact people with tuberculosis; his chest radiography was normal. -Kidneys and liver were donated and transplanted.

  5. Case Report Hospital do Rim e Hipertensão

  6. Case Report Hospital do Rim e Hipertensão *TB treatment: Coxcip4 (RIPZ)

  7. Case Report Recipient 3 (liver transplant recipient): The liver was transplanted at another center. This recipient started isoniazid prophylaxis after receiving information about possible donor’s tuberculosis infection. He has evolved well.

  8. Case Report Picture 1: Chronic granulomatous inflammation, caseous necrosis with epithelioid in subcapsular region, with positive Ziehl. (hematoxylin eosin -100X)

  9. Case Report Picture 2: Multifocal chronic epithelioid granulomatous inflammation. (hematoxylin eosin – 100X)

  10. Conclusions • These cases demonstrates the importance of screening for donor’s infections, especially Tuberculosis, endemic in Brazil.  • Collection of history is still the best form to suspect donor’s tuberculosis. • This report also demonstrates the importance of early diagnosis of infection in transplant patients, which may be presented like disseminated forms. • The comunication of  transmission suspicion to competent institutions was essential to avoid desease in other recipient.  Hospital do Rim e Hipertensão

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