Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris, France.
Nephrol Dial Transplant. 2011 Nov;26(11):3773-8. doi: 10.1093/ndt/gfr156. Epub 2011 Apr 5.
Kidney transplant recipients are at high risk of opportunistic infection. The aims of this study were to describe the epidemiology, clinical features and prognosis of Tuberculosis (TB) in kidney transplant recipients.
Retrospective observational study conducted in 14 French transplant centres involving all cases of TB that occurred in kidney transplant recipients between 1986 and 2006.
Among the 16146 kidney transplantations performed during the study period, 74 (0.45%) developed TB. The country of birth was a highly endemic area for TB in 20 (40.8%) patients. Time from kidney transplantation to TB was 10 months (4-27). Extrapulmonary and disseminated TB accounted for 33 (67.4%) cases. The most common symptoms were fever (71.7%), weight loss (41.3%) and asthenia (39.1%). Coexisting infections were diagnosed in 11 (22.4%) patients. Microbial sensitivity tests revealed no case of multidrug-resistant TB. Haemophagocytic syndrome associated with TB was diagnosed in 5 (10.2%) cases with 60% of mortality (P = 0.0005). Median length of antituberculous therapy was 12 (9.5-12) months. Immunosuppressive therapy was reduced in 22 (44.9%) patients without adverse consequence on the graft. Overall, hospital mortality was 6.1% and 1-year graft survival was 97%.
Kidney transplantation increases the risk of TB, with a high rate of extrapulmonary disease. Symptoms of infection are often attenuated, leading to delayed diagnosis. Overall prognosis is good but haemophagocytic syndrome is associated with high mortality. Country of birth might be taken into account in the decision of post-transplantation treatment of latent TB.
肾移植受者存在发生机会性感染的高风险。本研究的目的是描述肾移植受者中结核病（TB）的流行病学、临床特征和预后。
这是一项在法国 14 家移植中心进行的回顾性观察性研究，纳入了 1986 年至 2006 年间所有发生在肾移植受者中的 TB 病例。
在研究期间进行的 16146 例肾移植中，有 74 例（0.45%）发生 TB。20 例（40.8%）患者的原籍国是 TB 的高度流行地区。从肾移植到 TB 的时间为 10 个月（4-27）。肺外和播散性 TB 占 33 例（67.4%）。最常见的症状是发热（71.7%）、体重减轻（41.3%）和乏力（39.1%）。11 例（22.4%）患者同时诊断出其他感染。微生物敏感性试验未发现耐多药 TB。5 例（10.2%）患者诊断为与 TB 相关的噬血细胞综合征，死亡率为 60%（P = 0.0005）。抗结核治疗的中位时间为 12 个月（9.5-12）。22 例（44.9%）患者减少了免疫抑制治疗，但对移植物无不良影响。总的来说，住院死亡率为 6.1%，1 年移植物存活率为 97%。
肾移植增加了 TB 的风险，且肺部以外的疾病发病率较高。感染症状常被减弱，导致诊断延迟。总体预后良好，但噬血细胞综合征与高死亡率相关。原籍国可能会影响移植后潜伏性 TB 的治疗决策。
