Clinical presentation and outcome of tuberculosis in kidney, liver, and heart transplant recipients in Spain

被引:250
作者
Aguado, JM
Herrero, JA
Gavalda, J
TorreCisneros, J
Blanes, M
Rufi, G
Moreno, A
Gurgui, M
Hayek, M
Lumbreras, C
Morales, JM
Pahissa, A
Margerit, C
Prada, JL
Kindelan, JM
Ros, F
Pallardo, LM
Carratala, J
Gudiol, F
Gonzalez, J
Vilardell, J
Guirado, L
Rabella, N
机构
[1] HOSP 12 OCTUBRE, INFECT DIS UNIT, DEPT MICROBIOL, E-28041 MADRID, SPAIN
[2] HOSP 12 OCTUBRE, DEPT MICROBIOL, INFECT DIS UNIT, E-28041 MADRID, SPAIN
[3] HOSP GEN VALLE HEBRON, INFECT DIS SERV, BARCELONA, SPAIN
[4] CIUTAT SANTARIA BELLVITGE, INFECT DIS SERV, BARCELONA, SPAIN
[5] HOSP SANT PSU, INTERNAL MED SERV, BARCELONA, SPAIN
[6] HOSP REINA SOFIA, INFECT DIS UNIT, DEPT INTERNAL MED, CORDOBA, SPAIN
[7] HOSP LA FE, INFECT DIS UNIT, DEPT INTERNAL MED, E-46009 VALENCIA, SPAIN
关键词
D O I
10.1097/00007890-199705150-00015
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Tuberculosis is unusual in transplant recipients. The incidence, clinical manifestations, and optimal treatment of this disease in this population has not been adequately defined. The present study was undertaken to assess the incidence, clinical features, and response to therapy of Mycobacterium tuberculosis infection in solid-organ transplant recipients. Methods. We evaluated retrospectively the incidence, clinical characteristics, diagnostic procedures, antituberculous treatment, clinical course, and factors influencing mortality in 51 solid-organ transplant recipients who developed tuberculosis after transplantation. We also reviewed the world literature on tuberculosis in solid-organ transplantation. Results. The overall incidence of tuberculosis was 0.8%. The localization was pulmonary in 63% of the cases, disseminated in 25%, and extrapulmonary in 12%. Tuberculosis developed from 15 days to 13 years after surgery (mean, 23 months). In one third of the cases, diagnosis was not suspected initially, and in three cases, diagnosis was made at necropsy. Fever was the most frequent symptom, followed by constitutional symptoms, cough, respiratory insufficiency, and pleuritic pain. Fifteen patients (33%) developed hepatotoxicity during treatment; hepatotoxicity was severe in seven cases. Hepatotoxicity was higher in patients receiving four or more antituberculous drugs (50%) than in patients receiving three drugs (21%; P=0.03). Serum levels of cyclosporine decreased in the 26 patients under the simultaneous use of rifampin. Nine of them (35%) developed acute rejection, and five (56%) died, in comparison with 3 of 17 patients (18%) who did not develop rejection after the use of cyclosporine and rifampin (P=0.03). Although microbiological response was favorable in 94% of the 35 patients who completed 6 or more months of treatment, 16 other patients (31%) died before diagnosis or in the course of treatment. None of the patients treated for more than 9 months died as a consequence of tuberculosis, whereas the mortality rate was 33% among those treated for 6 to 9 months (P=0.03). Use of antilymphocyte antibodies or high doses of steroids for acute rejection before tuberculosis was associated with a higher mortality rate. Conclusions. M tuberculosis causes serious and potentially life-threatening disease in solid-organ transplant recipients. Treatment with at least three drugs during 9 months or more, avoiding the use of rifampin, appears to be appropriate.
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收藏
页码:1278 / 1286
页数:9
相关论文
共 55 条
  • [1] MYCOBACTERIAL INFECTIONS IN IMMUNOSUPPRESSED PATIENTS
    ABBOTT, MR
    SMITH, DD
    [J]. MEDICAL JOURNAL OF AUSTRALIA, 1981, 1 (07) : 351 - 353
  • [2] ALBATATA M, 1977, JAMA-J AM MED ASSOC, V237, P1465
  • [3] SUCCESSFUL USE OF RIFAMPICIN IN THE TREATMENT OF TUBERCULOSIS IN RENAL-TRANSPLANT PATIENTS IMMUNOSUPPRESSED WITH CYCLOSPORINE
    ALSULAIMAN, MH
    DHAR, JM
    ALKHADER, AA
    [J]. TRANSPLANTATION, 1990, 50 (04) : 597 - 598
  • [4] *AM THOR SOC, 1904, AM REV RESPIR DIS, V110, P371
  • [5] [Anonymous], 1986, AM REV RESPIR DIS, V134, P355
  • [6] INTERACTION OF RIFAMPIN AND GLUCOCORTICOIDS - ADVERSE EFFECT ON RENAL-ALLOGRAFT FUNCTION
    BUFFINGTON, GA
    DOMINGUEZ, JH
    PIERING, WF
    HEBERT, LA
    KAUFFMAN, HM
    LEMANN, J
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1976, 236 (17): : 1958 - 1960
  • [7] EFFECT OF RIFAMPICIN ON CYCLOSPORIN-A BLOOD-LEVELS IN A RENAL-TRANSPLANT RECIPIENT
    CASSIDY, MJD
    VANZYLSMIT, R
    PASCOE, MD
    SWANEPOEL, CR
    JACOBSON, JE
    [J]. NEPHRON, 1985, 41 (02): : 207 - 208
  • [8] CHAN GL, 1992, CLIN TRANSPLANT, V6, P141
  • [9] Costa J M, 1988, Acta Med Port, V1, P51
  • [10] COUTTS II, 1979, BRIT J DIS CHEST, V73, P141, DOI 10.1016/0007-0971(79)90025-1