Lopez de Castilla D, Schluger N W
Department of Epidemiology and Environmental Health Sciences, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, New York 10032, USA.
Transpl Infect Dis. 2010 Apr;12(2):106-12. doi: 10.1111/j.1399-3062.2009.00475.x. Epub 2009 Dec 9.
Organ transplantation places patients at risk for tuberculosis (TB), which constitutes a challenge to physicians due to its atypical and extrapulmonary presentations, complicated treatment issues, and high morbidity and mortality.
We identified all patients with TB following solid organ transplantation at a large university medical center in New York. Demographic data, transplant characteristics (type of organ and donor), underlying medical conditions, immunosuppressive drugs, rejection and opportunistic infections were analyzed, and a nested case-control study was performed to identify factors associated with the development of TB.
From 1988 to 2007, 4925 transplants were performed at Columbia University Medical Center: 1858 kidney, 857 liver, 1714 heart, 460 lung, and 36 heart/lung. Thirteen patients developed TB, for a cumulative incidence of 264/100,000. Of the 13 patients who developed TB, 10 had a kidney transplant, 2 had a lung transplant, and 1 had a heart transplant. The median time to develop TB was 11.2 (interquartile ratio: 4.4-23.0) months following transplantation. These cases were compared with 52 randomly selected control patients who had transplants not complicated by TB. Patients with TB were more likely to be renal transplant recipients (adjusted odds ratio [OR]: 4.59; 95% confidence interval [CI]: 1.07-19.67) and to be non-Caucasians (adjusted OR: 3.94; 95% CI: 0.99-15.56) than controls.
The incidence of TB in post-transplant patients is much higher than the overall background incidence in the United States. Non-Caucasian and kidney transplant recipients appear to be at increased risk of developing TB. This may be associated with prior exposure to TB before transplant in these populations.
器官移植使患者面临患结核病（TB）的风险，由于其非典型和肺外表现、复杂的治疗问题以及高发病率和死亡率，这对医生构成了挑战。
我们在纽约一家大型大学医学中心确定了所有实体器官移植后发生结核病的患者。分析了人口统计学数据、移植特征（器官和供体类型）、基础疾病、免疫抑制药物、排斥反应和机会性感染，并进行了一项巢式病例对照研究以确定与结核病发生相关的因素。
1988年至2007年，哥伦比亚大学医学中心进行了4925例移植手术：1858例肾脏移植、857例肝脏移植、1714例心脏移植、460例肺移植和36例心肺联合移植。13名患者发生了结核病，累积发病率为264/100,000。在发生结核病的13名患者中，10名接受了肾脏移植，2名接受了肺移植，1名接受了心脏移植。移植后发生结核病的中位时间为11.2（四分位间距：4.4 - 23.0）个月。将这些病例与52名随机选择的未发生结核病并发症的移植对照患者进行比较。与对照组相比，结核病患者更可能是肾移植受者（调整后的优势比[OR]：4.59；95%置信区间[CI]：1.07 - 19.67）且是非白种人（调整后的OR：3.94；95%CI：0.99 - 15.56）。
移植后患者的结核病发病率远高于美国的总体背景发病率。非白种人和肾移植受者发生结核病的风险似乎增加。这可能与这些人群在移植前曾接触过结核病有关。
