State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang, People's Republic of China.
PLoS One. 2018 Apr 16;13(4):e0195695. doi: 10.1371/journal.pone.0195695. eCollection 2018.
TB infection in patients after kidney transplantation remains a concern in a successful long-term outcome. This retrospective, descriptive study was performed on tuberculosis infection after kidney transplantation in the Department of Infectious Disease of the First Affiliated Hospital of Zhejiang University, a tertiary care hospital in China, from January 2011 to April 2017, with the aim to explain the clinical features of active tuberculosis after kidney transplantation and explore the correlated factors for diagnostic delay and mortality. It included 48 cases. All these cases were followed up for at least 12 months after anti-tuberculosis therapy, except the ones who died during this period. The median time of transplantation to active tuberculosis of these 48 patients was about 5.4 years. The time from a first hospital visit to the diagnosis (diagnostic delay) of 12 (25%) cases was more than 30 days. The correlated factors for the diagnostic delay more than 30 days were a fever for more than 2 weeks and antibiotic use for more than 2 weeks. Nine (18.8%) cases died during the anti-tuberculosis therapy or following-up period due to TB relapse. The risk factors for mortality were severe complications, such as encephaledema, severe pneumonia, intestinal perforation, liver function failure, and the following multiple-organ failure. In conclusion, the possibility of tuberculosis infection should be carefully assessed and sometimes diagnostic anti-tuberculosis therapy may be required for patients who had a fever for more than 2 weeks or used antibiotics for more than 2 weeks after kidney transplantation. Severe complications and the following multiple-organ failure might increase the mortality among these patients.
肾移植后患者的结核感染仍然是长期成功治疗的一个关注点。本回顾性描述性研究在浙江大学第一附属医院传染病科进行，研究对象为 2011 年 1 月至 2017 年 4 月期间在中国三级医院接受肾移植后发生结核感染的患者，旨在阐明肾移植后活动性结核的临床特征，并探讨诊断延迟和死亡率的相关因素。该研究共纳入 48 例患者。所有患者在抗结核治疗后至少随访 12 个月，除治疗期间死亡的患者外。48 例患者中，从移植到发生活动性结核的中位数时间约为 5.4 年。12 例（25%）患者从首次就诊到诊断（诊断延迟）的时间超过 30 天。诊断延迟超过 30 天的相关因素是发热超过 2 周和抗生素使用超过 2 周。9 例（18.8%）患者在抗结核治疗或随访期间因结核复发而死亡。死亡的危险因素为严重并发症，如脑水肿、严重肺炎、肠穿孔、肝功能衰竭和随后的多器官功能衰竭。总之，对于肾移植后发热超过 2 周或使用抗生素超过 2 周的患者，应仔细评估结核感染的可能性，有时可能需要进行诊断性抗结核治疗。严重并发症和随后的多器官功能衰竭可能会增加这些患者的死亡率。
