Section of Infectious Diseases, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
Division of Infectious Diseases, Department of Medicine, The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA.
Clin Transplant. 2018 Jun;32(6):e13259. doi: 10.1111/ctr.13259. Epub 2018 May 7.
Mycobacterium tuberculosis (TB) is a common pathogen worldwide, and it may cause significant infection after solid organ transplantation (SOT). We reviewed all reported TB cases to provide an update on its epidemiology, clinical presentation, management, and outcome after SOT.
MEDLINE, EMBASE, and OVID were reviewed from January 1, 1998, to December 31, 2016, using keywords tuberculosis and solid organ transplant or transplantation.
There were 187 publications reporting 2082 cases of TB among kidney (n = 1719), liver (n = 253), heart (n = 77), lung (n = 25), and kidney-pancreas (n = 8) recipients. Among cohort studies, the median incidence was 2.37% (range, 0.05%-13.27%) overall. Most TB disease was considered reactivation of latent infection, occurring beyond the first year after SOT. Early-onset cases were seen among donor-derived TB cases. Fever was the most common symptom. Radiologic findings were highly variable. Extrapulmonary and disseminated TB occurred 29.84% and 15.96%, respectively. Multidrug-resistant TB was rare. Treatment using 4 or 5 drugs was commonly associated with hepatotoxicity and graft dysfunction. All-cause mortality was 18.84%.
This large review highlights the complexity of TB after SOT. Reactivation TB, donor-transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction.
结核分枝杆菌（TB）是一种全球常见的病原体，在实体器官移植（SOT）后可能会引起严重感染。我们回顾了所有报道的 TB 病例，以提供其在 SOT 后的流行病学、临床表现、治疗和结局的最新信息。
使用“结核”和“实体器官移植或移植”等关键词，于 1998 年 1 月 1 日至 2016 年 12 月 31 日在 MEDLINE、EMBASE 和 OVID 上进行了检索。
有 187 篇文献报道了 2082 例肾（n=1719）、肝（n=253）、心（n=77）、肺（n=25）和肾-胰腺（n=8）受者的 TB 病例。在队列研究中，总体中位发病率为 2.37%（范围，0.05%-13.27%）。大多数 TB 疾病被认为是潜伏感染的再激活，发生在 SOT 后 1 年以上。早期发病见于供体来源的 TB 病例。发热是最常见的症状。放射学表现高度多变。肺外和播散性 TB 分别占 29.84%和 15.96%。耐多药 TB 罕见。使用 4 或 5 种药物治疗常与肝毒性和移植物功能障碍有关。全因死亡率为 18.84%。
这项大型综述强调了 SOT 后 TB 的复杂性。再激活性 TB、供体传播感染、肺外受累和播散性疾病很常见。TB 的治疗常与肝毒性和移植物功能障碍有关。
