Patiet with leprosy awaiting renal transplant

Leprosy Mailing List – May 4^th, 2011

Ref:     Patiet with leprosy awaiting renal transplant
From:  V. Jain,  V. Halwai, R Ganapati, Mumbay, India

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Dear Dr Noto,

Renal damage due to repeated Type 2 (erythema nodosum leprosum) reaction used to be seen during dapsone monotherapy period.  We (RG) have  observed irreversible nephropathy as the  the cause of death in some such patients in leprosy hospitals.  The science of nephrology was not so advanced in those days.  Since the advent of MDT and effective management of reactions, such morbidity has considerably reduced.

We have been reading with interest the correspondence on the above subject and are keen to know the follow up of the patient.  We may bring to the notice of your readers the abstrct of the article on "renal transplantation in leprosy patients"  reported from Brazil by

Roselino Am, de Almeidia Am, Foss NT, LimaVJ, Raspanti EO, Ferraz AS, in the Int  J. Lepr Other Mycobact Dis, 1993 Mar;61(1): 102-5

"We report four cases of leprosy in renal transplant recipients, two of whom had the disease before transplantation and no signs of relapse even in the presence of immunosuppressive drugs. The other two cases presented with lepromatous and borderline (dimorphous) leprosy 5 months and 5 years after transplantation, respectively. The disease of the last patient was controlled with sulfone even in the presence of immunosuppressive drugs, but the mechanism whereby the first patient rapidly developed lepromatous leprosy is unclear, even though he was a home contact of a patient with lepromatous leprosy (his wife).  In view of the data presented here, we do not contraindicate renal transplantation in patients with leprosy who frequently suffer changes in renal function. We believe that renal function should be periodically evaluated in patients with borderline and lepromatous leprosy".

Thanking you,

Vivika Jain,  Vikas Halwai and R Ganapati,

Bombay Leprosy Project,