Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
Transplantation. 2019 Jan;103(1):210-215. doi: 10.1097/TP.0000000000002340.
Tuberculosis (TB) is a significant opportunistic infection in solid organ transplant recipients (SOTR). There are limited data on TB incidence in transplantation from low prevalence countries as well as on long-term TB-specific immune responses.
We performed a single-center retrospective review of SOTR diagnosed with active TB between 2000 and 2015 and further contacted the available patients for a study of long-term T-cell responses using an interferon-gamma (IFN-γ) release assay and a flow cytometry-based assay.
We identified 31 SOTR with active TB for an incidence of 62 cases/100 000 patient-years. Nineteen (61.3%) of 31 patients were diagnosed within the first year after transplant. Nineteen (61.3%) were born in countries with high TB prevalence and disseminated disease occurred in 22.6%. No patient had been screened for latent TB infection pretransplant. The majority of patients received isoniazid and a rifamycin as part of multidrug regimen. In addition, 13 (44.8%) of 29 patients received quinolones. One-year mortality in this population was 19.4%. Eight patients were available for long-term immune responses. Of these, all had detectable IFN-γ response by IFN-γ release assay testing and 7 of 8 had detectable TB-specific T cells, primarily central and effector T-cell responses in the CD4 compartment and terminally differentiated T cells in the CD8 compartment.
TB has high incidence in SOTR even in low-prevalence regions but especially targets patients who originated from TB-endemic countries. Long-term TB-specific T-cell responses were found in the majority of patients.
结核病（TB）是实体器官移植受者（SOTR）的重大机会性感染。来自低流行国家的移植中结核病发病率以及长期的结核病特异性免疫反应数据有限。
我们对 2000 年至 2015 年间确诊为活动性结核病的 SOTR 进行了单中心回顾性研究，并进一步联系了可用的患者，使用干扰素-γ（IFN-γ）释放试验和基于流式细胞术的试验研究长期 T 细胞反应。
我们确定了 31 名患有活动性结核病的 SOTR，发病率为 62 例/100000 患者年。31 名患者中有 19 名（61.3%）在移植后一年内被诊断出。19 名（61.3%）患者出生于结核病高流行国家，且 22.6%的患者发生播散性疾病。移植前没有患者接受潜伏性结核病感染筛查。大多数患者接受异烟肼和利福霉素作为多药方案的一部分。此外，29 名患者中有 13 名（44.8%）接受了喹诺酮类药物。该人群的 1 年死亡率为 19.4%。8 名患者可进行长期免疫反应。其中，所有患者的 IFN-γ释放试验均检测到可检测的 IFN-γ 反应，8 例中有 7 例检测到结核病特异性 T 细胞，主要是 CD4 区的中央和效应 T 细胞反应以及 CD8 区的终末分化 T 细胞。
即使在低流行地区，结核病在 SOTR 中的发病率也很高，但特别针对来自结核病流行国家的患者。大多数患者都发现了长期的结核病特异性 T 细胞反应。
