Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Infectious Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Transpl Infect Dis. 2021 Jun;23(3):e13566. doi: 10.1111/tid.13566. Epub 2021 Jan 25.
Tuberculosis (TB) is considered as a challenge issue in solid organ transplant recipients because of high morbidity and mortality. Active TB after transplant mostly occurs from reactivation of latent infection. Understanding risk factors and clinical information of TB may provide an appropriate prevention and treatment strategies in this specific patient population, however data from high endemic area is scarce.
A matched single-center, case-control study was conducted in our institute. Cases were defined as newly diagnosed confirmed or clinical active TB in patients who underwent kidney transplant (KT) between April 1992 and October 2018. For each case, 5 controls were matched by age and sex. Risk factor associated with TB was determined using univariate and multivariate conditional logistic regression.
Between study period, KT was performed in 787 patients. Twenty-seven patients (3.43%) were diagnosed with active TB including 20 confirmed and 7 clinical diagnosed cases. The global incidence of TB in our population was 315 cases per 100 000 patients per year. Among 27 cases, pulmonary involvement was the most common (48.1%) followed by disseminated (18.5%), extrapulmonary (14.8%), pleura (11.1%) and pleuropulmonary (7.4%) TB. Allograft rejection was significantly associated with active TB (P < .001). The median onset duration of infection was 17 months (IQR, 4-59 months) after KT. Twenty-four (88.9%) patients received rifampicin containing regimen for treatment with median duration of 10 months (IQR, 6-12 months). All patients were cured after complete treatment, however those with TB remained having unfavorable outcomes including higher all-cause mortality and graft loss.
Incidence rate of TB in KT recipients is higher than normal population. Allograft rejection was identified as a significant risk factor. Increase unfavorable outcomes including graft loss and mortality were also observed among patients with TB.
结核病（TB）被认为是实体器官移植受者的一个挑战问题，因为其发病率和死亡率都很高。移植后活动性 TB 主要由潜伏感染的再激活引起。了解 TB 的危险因素和临床信息可能为这一特定患者群体提供适当的预防和治疗策略，但来自高流行地区的数据却很少。
在我们的机构中进行了一项匹配的单中心病例对照研究。病例定义为 1992 年 4 月至 2018 年 10 月期间接受肾移植（KT）的患者中诊断为新发确诊或临床活动性 TB 的患者。每个病例匹配 5 个年龄和性别相匹配的对照。使用单变量和多变量条件逻辑回归确定与 TB 相关的危险因素。
在研究期间，787 名患者接受了 KT。27 名患者（3.43%）被诊断为活动性 TB，包括 20 例确诊和 7 例临床确诊病例。我们人群中的 TB 总发病率为每年每 100000 名患者中有 315 例。在 27 例患者中，肺部受累最常见（48.1%），其次是播散性（18.5%）、肺外（14.8%）、胸膜（11.1%）和胸膜肺（7.4%）TB。移植物排斥与活动性 TB 显著相关（P<.001）。感染的中位发病时间为 KT 后 17 个月（IQR，4-59 个月）。24 名（88.9%）患者接受了利福平含药方案治疗，中位疗程为 10 个月（IQR，6-12 个月）。所有患者在完全治疗后均痊愈，但 TB 患者的预后较差，包括更高的全因死亡率和移植物丢失。
KT 受者的 TB 发病率高于普通人群。移植物排斥被确定为一个显著的危险因素。TB 患者的不良预后发生率也更高，包括移植物丢失和死亡率。
