Hsu Meng-Shiuan, Wang Jiun-Ling, Ko Wen-Je, Lee Po-Huang, Chou Nai-Kwan, Wang Shoei-Shen, Chu Shu-Hsun, Chang Shan-Chwen
Far Eastern Memorial Hospital, Taipei, Taiwan.
Am J Med Sci. 2007 Aug;334(2):106-10. doi: 10.1097/MAJ.0b013e31812f5a4e.
: Taiwan is an area with moderate to high incidence of Mycobacterium tuberculosis infection. The risk of M tuberculosis infection in transplantation recipients is considered to be significant. Our aim in this study was to investigate the clinical spectrums of M tuberculosis-infected transplantation recipients in a southeast Asian country, Taiwan.
: We retrospectively analyzed the demographic data, clinical features, treatment, and outcome of M tuberculosis infection in kidney, heart, and liver transplant recipients from May 1996 to April 2005 at the National Taiwan University Hospital.
: Fifteen patients who had received solid organ transplantation developed tuberculosis (kidney = 6, heart = 7, liver = 2). The median duration from transplantation to diagnosis of tuberculosis was 31 months. The cumulative incidence of post-transplantation tuberculosis was 2.0% (15/760), ie, approximately 3 times that of the general population. Ten patients (66.7%) had pulmonary tuberculosis, 1 (6.7%) had extrapulmonary tuberculosis, and 4 (26.7%) had disseminated tuberculosis. Nine patients completed the anti-tuberculosis treatment; the median treatment duration was 12 months (pulmonary: 9 months; extrapulmonary: 13.5 months). No treatment failure was noted in patients receiving the complete treatment course. The graft failure and mortality rates of post-transplantation tuberculosis were 13.3% each (2/15). The tuberculosis-associated mortality rate was 6.7% (1/15).
: Cumulative incidence of tuberculosis was slightly higher in transplant recipients than in the general population in Taiwan. Conventional 4-combined anti-tuberculosis regimen for 12 months can treat the potentially fatal infection successfully in post-transplantation tuberculosis patients without recurrence.
台湾是结核分枝杆菌感染发病率中到高的地区。移植受者感染结核分枝杆菌的风险被认为很大。本研究的目的是调查东南亚国家台湾地区感染结核分枝杆菌的移植受者的临床谱。
我们回顾性分析了1996年5月至2005年4月在台湾大学医院接受肾脏、心脏和肝脏移植的受者中结核分枝杆菌感染的人口统计学数据、临床特征、治疗及结局。
15例接受实体器官移植的患者发生了结核病（肾脏移植6例，心脏移植7例，肝脏移植2例）。从移植到诊断为结核病的中位时间为31个月。移植后结核病的累积发病率为2.0%（15/760），即约为普通人群的3倍。10例患者（66.7%）患有肺结核，1例（6.7%）患有肺外结核，4例（26.7%）患有播散性结核。9例患者完成了抗结核治疗；中位治疗时间为12个月（肺结核：9个月；肺外结核：13.5个月）。接受完整疗程治疗的患者未出现治疗失败。移植后结核病的移植物失败率和死亡率均为13.3%（2/15）。结核病相关死亡率为6.7%（1/15）。
台湾地区移植受者结核病的累积发病率略高于普通人群。常规的4种联合抗结核方案治疗12个月可成功治疗移植后结核病患者的潜在致命感染且无复发。
