Department of Nephrology, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
Clin Transplant. 2013 Sep-Oct;27(5):E591-6. doi: 10.1111/ctr.12210. Epub 2013 Aug 8.
Kidney transplant recipients are at a high risk of opportunistic infection. The aims of this study were to describe the epidemiology, clinical features, and prognosis of abdominal tuberculosis (TB) in kidney transplant recipients.
All cases of abdominal TB that occurred in kidney transplant recipients at our center between 1998 and 2010 were retrospectively reviewed. Detailed demographic data, clinical profile information, and the treatment response were recorded.
Among the 7833 kidney transplantations performed during the study period, eight patients (0.1%) developed abdominal TB. There were four men and four women in this group. The mean age of the patients was 44 ± 12 yr. The time from kidney transplantation to TB was 6.7 ± 3.4 yr. The symptoms were weight loss (87.5%), diarrhea (87.5%), fever (75%), abdominal pain (62.5%), and lower gastrointestinal bleeding (37.5%). The delay between the identification of the clinical symptoms and the diagnosis was an average of six months. The diagnosis was confirmed histopathologically for most patients. The cecum and ascending colon were the most common sites involved. Two patients required surgical intervention. Five patients received a 4-drug regimen, and three had hepatotoxicity. The median length of antituberculous therapy was nine (6-12) months. Five patients lost their graft. Overall, the hospital mortality was 12.5%.
Kidney transplantation increases the risk of TB, particularly as an extrapulmonary disease. The symptoms of infection are often attenuated, leading to delayed diagnosis. Therefore, a careful approach to the patient and supportive data are necessary to make the final and timely diagnosis.
肾移植受者存在发生机会性感染的高风险。本研究旨在描述肾移植受者腹腔结核（TB）的流行病学、临床特征和预后。
回顾性分析 1998 年至 2010 年我院发生的所有腹腔 TB 肾移植受者病例。记录详细的人口统计学数据、临床特征信息和治疗反应。
在研究期间进行的 7833 例肾移植中，8 例（0.1%）发生了腹腔 TB。该组有 4 名男性和 4 名女性，平均年龄为 44 ± 12 岁。从肾移植到 TB 的时间为 6.7 ± 3.4 年。症状为体重减轻（87.5%）、腹泻（87.5%）、发热（75%）、腹痛（62.5%）和下消化道出血（37.5%）。从临床症状出现到诊断的平均延迟时间为 6 个月。大多数患者通过组织病理学确诊。最常见的受累部位是盲肠和升结肠。2 例患者需要手术干预。5 例患者接受了 4 药方案，3 例出现肝毒性。抗结核治疗的中位时间为 9（6-12）个月。5 例患者失去了移植物。总体而言，医院死亡率为 12.5%。
肾移植会增加 TB 的风险，特别是肺部外疾病。感染的症状常被削弱，导致诊断延迟。因此，需要仔细对待患者并提供支持性数据，以便做出最终和及时的诊断。
