Sun Hsin-Yun
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Curr Opin Infect Dis. 2014 Dec;27(6):501-5. doi: 10.1097/QCO.0000000000000102.
To summarize recent findings in the management of active tuberculosis (TB) in solid organ transplant (SOT) recipients.
Mycobacterium tuberculosis causes substantial morbidity and mortality in SOT recipients. According to the literature, transplantation might not be an absolute contraindication for patients with active TB. Although the use of rifampin, resulting in the decreased levels of calcineurin inhibitors, might lead to rejection, studies showed that rifampin-based regimens did not appear to be associated with post-TB rejection or mortality. Nevertheless, judicious adjustment and close monitoring of immunosuppressant levels during concurrent rifampin use for patients with active TB are needed. TB-associated immune reconstitution syndrome occurred in 14% of SOT recipients; liver transplantation, cytomegalovirus infection, and rifampin use are identified risk factors for the development of immune reconstitution syndrome.
Patients with active TB might be able to undergo transplantation if indicated. Rifampin-based regimen can be considered in the treatment of TB in SOT recipients. In addition to HIV-positive patients, immune reconstitution syndrome also occurs in SOT recipients, and deserves the recognition by primary care physicians to avoid unnecessary management.
总结实体器官移植（SOT）受者活动性结核病（TB）管理的最新研究结果。
结核分枝杆菌在SOT受者中可导致严重的发病率和死亡率。根据文献，移植可能并非活动性TB患者的绝对禁忌证。虽然使用利福平会导致钙调神经磷酸酶抑制剂水平降低，可能会引发排斥反应，但研究表明，基于利福平的治疗方案似乎与TB后排斥反应或死亡率无关。尽管如此，对于活动性TB患者在同时使用利福平时，仍需要对免疫抑制剂水平进行审慎调整和密切监测。14%的SOT受者发生了TB相关免疫重建综合征；肝移植、巨细胞病毒感染和使用利福平是免疫重建综合征发生的确定危险因素。
如有指征，活动性TB患者可能能够接受移植。对于SOT受者的TB治疗可考虑采用基于利福平的治疗方案。除了HIV阳性患者外，免疫重建综合征也发生在SOT受者中，值得基层医疗医生认识，以避免不必要的处理。
