Current possibilities of monitoring tuberculosis infection among kidney transplant candidates and kidney transplant recipients

Aim of the study. To determine the possibilities of monitoring tuberculosis infection among kidney transplant candidates and kidney transplant recipients using modern radiological examination methods. Materials and methods. In the period from 2012 to 2025, 63 patients with stage 5 CKD were examined at the Central Research Institute of Tuberculosis for tuberculosis infection of varying degrees of activity. According to the activity of the tuberculosis process, the patients were divided into 2 groups: patients with active tuberculosis — 23 people (36.5%), patients with residual post-tuberculous changes — 40 people (63.5%). A retrospective analysis of the results of radiation examination methods before the diagnosis of tuberculosis and at the time of diagnosis was carried out to identify residual post-tuberculosis changes (RPTC). For patients with RPTC, an analysis of the radiation examination methods results was also carried out before the diagnosis of the process and then for a long time with regular monitoring by the CT of the chest once every 6 months under the   supervision of specialists. Results and discussion. Among CKD 5 stage patients with active tuberculosis, patients with widespread and complicated clinical forms of tuberculosis prevailed 17/23 people (73.9%): polyorgan tuberculosis — 6/23 people (26.1%), infiltrative pulmonary tuberculosis in the decay phase or with signs of complications (with bronchial damage) — 6/23 people (26.1%), disseminated pulmonary tuberculosis 3/23 people (13%) and others, which indicated late detection of the disease. It was found that the majority of patients (16/23 people (69.6%) had signs of RPTC at the time of active tuberculosis process diagnosis. When assessing the volume of RPTC, it was determined that large changes — 10/16 people (62.5%) prevailed. When assessing the localization of the tuberculosis process reactivation, it was found that in most cases 13/16 people (81.3%) the zone of inflammation development corresponded to the location of the transferred tuberculosis process signs. In this case, patients with CKD stage 5 with RPTC (40 people) were observed by specialists of Central Research Institute of Tuberculosis for a long time (more than 1 year, on average 3.86 years) with the performance of CT chest 1 time in 6 months, having received a course of chemoprophylaxis in a timely manner. 39/40 people (97.5%) did not have signs of tuberculosis reactivation, even after kidney transplantation or other events that aggravate the immunodeficiency state. Conclusion. In most patients with CKD stage five (69.6% of observations), the RPTC presence preceded the development of active tuberculosis, and in most cases (73.9%) of widespread and/or complicated tuberculosis processes. In this case, the zone of reactivation of the tuberculosis process in the observed patients mainly coincided with the localization of RPTC (81.3%). While observation of CKD stage 5 patients with RPTC using CT of the chest as a radiological examination made it possible in 97.5% of observations to promptly prescribe additional examination and carry out prevention of tuberculosis   reactivation in patients with CKD stage 5.

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