Giacomelli Irai Luis, Schuhmacher Neto Roberto, Marchiori Edson, Pereira Marisa, Hochhegger Bruno
Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil.
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
J Bras Pneumol. 2018 Apr;44(2):161-166. doi: 10.1590/s1806-37562017000000459.
The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.
本系统评价的目的是筛选出包含实体器官移植（肺、肾或肝）后发生肺结核患者胸部X线或胸部CT检查结果的文章。使用了以下检索词：“结核病”；“移植”；“移植术”；“分枝杆菌”；以及“肺”。本评价使用的数据库是PubMed和巴西虚拟健康图书馆（Virtual Health Library）。我们选择了发表年份不限的英文、葡萄牙文或西班牙文文章，这些文章在标题、摘要或正文符合入选标准。排除没有胸部CT或胸部X线检查结果数据的文章，以及与实体器官移植或肺结核无关的文章。我们筛选出29篇文章，共涉及219例患者。样本量最大的研究分别在巴西和韩国进行（分别为78例和35例患者）。影像学表现分为五种常见类型。这些患者的影像学表现因移植器官而异。在肝移植和肺移植受者中，最常见的类型是肺结核的典型表现（空洞形成和“树芽征”结节），这与普通人群肺结核的表现相似。粟粒样表现和淋巴结肿大的病例比例在肾移植受者中最高，这与合并感染结核和HIV患者的表现最为相似。为了更好地了解这些影像学表现在此人群中的分布情况，需要进一步评估免疫抑制方案等临床数据的研究。
