Rungruanghiranya S, Ekpanyaskul C, Jirasiritum S, Nilthong C, Pipatpanawong K, Mavichak V
Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand.
Transplant Proc. 2008 Sep;40(7):2376-9. doi: 10.1016/j.transproceed.2008.07.034.
Tuberculosis (TB) is a leading cause of morbidity and mortality in renal transplant recipients, especially in developing countries. Its incidence and characteristics remain unknown in Thai recipients. This study sought to determine the incidence, characteristics, risk factors, and outcome of TB in Thailand.
We retrospectively reviewed case records of all renal transplant recipients from 1992 to 2007 to record demographic information, transplant characteristics, median time to diagnosis of TB, and outcomes.
Among 270 recipients, 9 (3.84%, 95% confidence interval [CI] 1.18%-5.49%) developed TB. Their median age was 40 years (range = 23-62 years) and median time from transplantation to diagnosis was 36 months (range = 4-115 months). Although pulmonary TB was the most common form (56%), 2 patients (22%) developed extrapulmonary disease. Disseminated TB occurred in 2 patients (22%). The diagnosis was made on respiratory specimen cultures in 3 cases (33.3%) and body fluid cultures in 3 (33.3%). Five patients (55.6%) were successfully treated with four-drug combination therapy. Two of the other subjects (22.2%) who received triple therapy were noncompliant, succumbing to graft failure and sepsis. Blood group AB (odds ratio [OR] 10.95, 95% CI 1.57-76.60) and use of tacrolimus rescue therapy (OR 9.68, 95% CI 2.13-43.94) were associated with an elevated risk of TB.
TB is common among Thai renal transplant recipients with an incidence 27 times higher than that of the general Thai population. The extrapulmonary form in particular occurs more frequently with an increased risk of mortality.
结核病是肾移植受者发病和死亡的主要原因，在发展中国家尤为如此。泰国肾移植受者中结核病的发病率及其特征尚不清楚。本研究旨在确定泰国结核病的发病率、特征、危险因素及转归。
我们回顾性分析了1992年至2007年期间所有肾移植受者的病例记录，以记录人口统计学信息、移植特征、结核病诊断的中位时间及转归。
在270例受者中，9例（3.84%，95%置信区间[CI]1.18%-5.49%）发生了结核病。他们的中位年龄为40岁（范围=23-62岁），从移植到诊断的中位时间为36个月（范围=4-115个月）。尽管肺结核是最常见的类型（56%），但有2例患者（22%）发生了肺外结核。播散性结核发生在2例患者（22%）中。3例（33.3%）通过呼吸道标本培养确诊，3例（33.3%）通过体液培养确诊。5例患者（55.6%）接受四联药物联合治疗后成功治愈。另外2例接受三联疗法的患者（22.2%）不依从治疗，死于移植失败和败血症。AB血型（比值比[OR]10.95，95%CI 1.57-76.60）和使用他克莫司挽救治疗（OR 9.68，95%CI 2.13-43.94）与结核病风险升高相关。
结核病在泰国肾移植受者中很常见，发病率比泰国普通人群高27倍。特别是肺外结核形式更为常见，死亡风险增加。
