Clinical presentation and outcome of tuberculosis in kidney, liver, and heart transplant recipients in Spain. Spanish Transplantation Infection Study Group, GESITRA.

摘要: Background Tuberculosis is unusual in transplant recipients. The incidence, clinical manifestations, and optimal treatment of this disease population has not been adequately defined. present study was undertaken to assess the features, response therapy Mycobacterium tuberculosis infection solid-organ Methods We evaluated retrospectively characteristics, diagnostic procedures, antituberculous treatment, course, factors influencing mortality 51 recipients who developed after transplantation. also reviewed world literature on Results overall incidence 0.8%. localization pulmonary 63% cases, disseminated 25%, extrapulmonary 12%. from 15 days 13 years surgery (mean, 23 months). In one third diagnosis suspected initially, three made at necropsy. Fever most frequent symptom, followed by constitutional symptoms, cough, respiratory insufficiency, pleuritic pain. Fifteen patients (33%) hepatotoxicity during treatment; severe seven cases. Hepatotoxicity higher receiving four or more drugs (50%) than (21%; P=0.03). Serum levels cyclosporine decreased 26 under simultaneous use rifampin. Nine them (35%) acute rejection, five (56%) died, comparison with 3 17 (18%) did develop rejection rifampin (P=0.03). Although microbiological favorable 94% 35 completed 6 months 16 other (31%) died before course treatment. None treated for 9 as a consequence tuberculosis, whereas rate 33% among those Use antilymphocyte antibodies high doses steroids associated rate. Conclusions M causes serious potentially life-threatening Treatment least more, avoiding rifampin, appears be appropriate.