Renal Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Clin Transplant. 2013 Mar-Apr;27(2):E169-76. doi: 10.1111/ctr.12077. Epub 2013 Jan 28.
Among kidney transplant recipients (KTRs), tuberculosis is one of the most common opportunistic infections and is associated with high morbidity and mortality. The aim of this study was to describe the incidence, clinical features, and prognosis of tuberculosis in KTRs.
Retrospective single-center observational study involving all cases of tuberculosis in KTRs between 2000 and 2010.
Of the 1549 KTRs evaluated, 43 (2.8%) developed tuberculosis, translating to an annual incidence of 803 cases/100 000 patients, considerably higher than that reported for the general population of Brazil. The median time to tuberculosis (TB) onset after transplantation was 196 d (range, 19-3626 d). Of the KTRs with tuberculosis, 67% became infected within the first year post-transplant, 74% had pulmonary tuberculosis, and 7% had a previous history of active tuberculosis. No tuberculosis prophylaxis was employed before or after transplantation. The most common symptoms were fever (in 79%), cough (in 35%), and dyspnea (in 16%). The median time from the onset of symptoms to the start of treatment was 28 d. The median duration of antituberculosis therapy was 196 d. In 15 patients (35%), the immunosuppressive therapy was reduced, and the incidence of acute rejection was higher in patients with tuberculosis than in those without (44% vs. 28%). Mortality during tuberculosis treatment was 12% (5 cases), and all five deaths were attributed to tuberculosis. Ten-yr death-censored graft survival and patient survival were similar between patients with tuberculosis and those without.
Among KTRs, symptoms of tuberculosis are often attenuated, which leads to delayed diagnosis, and tuberculosis-related mortality remains high.
在肾移植受者（KTR）中，结核病是最常见的机会性感染之一，与高发病率和死亡率相关。本研究的目的是描述 KTR 中结核病的发生率、临床特征和预后。
这是一项回顾性单中心观察性研究，纳入了 2000 年至 2010 年间 KTR 中所有结核病病例。
在评估的 1549 例 KTR 中，43 例（2.8%）发生了结核病，发病率为 803 例/100000 例，明显高于巴西普通人群的报告发病率。移植后结核病（TB）发病的中位时间为 196 天（范围，19-3626 天）。在结核病 KTR 中，67%在移植后 1 年内感染，74%患有肺结核，7%有活动性肺结核既往史。在移植前后均未进行结核病预防。最常见的症状是发热（79%）、咳嗽（35%）和呼吸困难（16%）。从症状出现到开始治疗的中位时间为 28 天。抗结核治疗的中位持续时间为 196 天。在 15 例（35%）患者中，免疫抑制治疗减少，结核病患者的急性排斥反应发生率高于无结核病患者（44% vs. 28%）。结核病治疗期间的死亡率为 12%（5 例），所有 5 例死亡均归因于结核病。结核病患者和无结核病患者的 10 年死亡风险校正移植物存活率和患者存活率相似。
在 KTR 中，结核病的症状常不明显，导致诊断延迟，结核病相关死亡率仍然较高。
