Siu Y P, Tong M K H, Leung K T, Yung C Y
Division of Nephrology, Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.
Transpl Infect Dis. 2004 Sep;6(3):132-5. doi: 10.1111/j.1399-3062.2004.00067.x.
Opportunistic infections, and in particular tuberculosis (TB), carry substantial morbidity and mortality in solid organ transplant recipients. We report a 39-year-old man who underwent a cadaveric renal transplant. Three months postoperatively, he was diagnosed to have tuberculous infection of his graft kidney manifested as fever and renal impairment. The diagnosis was confirmed by renal biopsy, which showed granuloma formation and positive stain for acid-fast bacilli (AFB). His systemic symptoms responded well to a complete course of anti-tuberculous therapy, but his renal function continued to deteriorate. Graft nephrectomy was performed and the patient underwent a second kidney transplant 1 year later. He remained well and asymptomatic thereafter. No signs of recurrence of tuberculous infection were noted up until the present time. This case illustrates that TB remains an important threat to transplant recipients. Although reactivation of dormant TB is the usual mode of infection, acquisition from the donor graft is also possible. The latter may account for the infection in our case, as our patient had a negative tuberculin skin test and normal chest radiograph prior to transplant. The identification of AFB in the kidney graft less than 3 months postoperatively also suggested that causal relationship. While diagnosing TB in post-transplant recipients is difficult and may require renal biopsy, as in our case, treatment on the other hand is no different from the standard protocols. However, no consensus has been reached on the safety of re-transplantation. Also, the need for graft nephrectomy and chemoprophylaxis remains unclear.
机会性感染，尤其是结核病，在实体器官移植受者中会导致严重的发病和死亡。我们报告一名39岁接受尸体肾移植的男性。术后三个月，他被诊断为移植肾结核感染，表现为发热和肾功能损害。肾活检证实了诊断，活检显示有肉芽肿形成且抗酸杆菌（AFB）染色呈阳性。他的全身症状对抗结核治疗的完整疗程反应良好，但肾功能持续恶化。于是进行了移植肾切除术，患者在1年后接受了第二次肾移植。此后他一直状况良好且无症状。截至目前未发现结核感染复发的迹象。该病例表明，结核病仍然是移植受者的一个重要威胁。虽然潜伏性结核的重新激活是常见的感染方式，但也有可能从供体移植物中获得感染。在我们的病例中，后一种情况可能是感染原因，因为我们的患者在移植前结核菌素皮肤试验呈阴性且胸部X光片正常。术后不到3个月在移植肾中发现抗酸杆菌也提示了这种因果关系。虽然像我们的病例一样，在移植后受者中诊断结核病很困难且可能需要肾活检，但另一方面治疗与标准方案并无不同。然而，对于再次移植的安全性尚未达成共识。此外，移植肾切除术和化学预防的必要性仍不明确。
