Nocardiosis in tropical renal transplant recipients.

BACKGROUND

The epidemiology of nocardiosis in the tropics among renal transplant recipients has not been reported.

METHODS

An evaluation of nocardiosis for 30 yr in one of the large transplant centres in South Asian region.

RESULTS

Of the 1968 patients who received primary renal allografts at Christian Medical College & Hospital, 27 patients developed nocardiosis over 30 yr. Early nocardiosis (</= 2 yr) was associated with chronic liver disease and the use of cyclosporin (CsA) as compared with its later occurrence (>2 yr). Seventeen patients (63%) had two or more associated post-transplant infections, of whom 10 had tuberculosis. Mortality in these patients was associated with chronic liver disease.

CONCLUSIONS

Nocardiosis manifests earlier (<2 yr) in CsA treated patients who have chronic liver disease. Among renal transplant recipients of the tropics nocardiosis is a marker of a high susceptibility to tuberculosis and other infections, the association with tuberculosis is stronger in those developing early nocardiosis (<2 yr). Chronic liver disease is a risk factor for death in patients with nocardiosis especially when associated with tuberculosis. This report constitutes the largest single centre experience among renal transplant recipients.