Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brasil.
Universidade Católica de Brasília, Brasília, DF, Brasil.
J Bras Nefrol. 2022 Jan-Mar;44(1):126-129. doi: 10.1590/2175-8239-JBN-2020-0117.
Tuberculosis (TB) is a possible serious complication of solid organ transplantation, associated with high mortality and morbidity. Post-transplant TB has varied pathogenesis with many approaches to its prevention, which is the most important way to reduce its incidence. Treatment of TB in organ recipients is challenging because of drug toxicity and interaction with immunosuppressants.
an 18-year-old woman that underwent kidney transplantation from a deceased donor and was discharged with fair renal function was readmitted at 37th postoperative day with fever. CT showed signs of miliary TB and fluid collection besides graft fistulization through the skin. The patient presented positive BAAR in the drained fluid and Koch's bacillus in the urine. She was treated with a four-drug regimen (rifampicin, isoniazid, pyrazinamide, and etambutol), with great response and preserved graft function. We were informed that the recipient of the contralateral kidney also presented post-transplant TB, implying in a donor-derived origin.
TB is an important differential diagnosis for infectious complications in patients after solid-organ transplantation, especially in endemic regions. Its initial clinical presentation can be unspecific and it should be suspected in the presence of fever or formation of fluid collections. The suspicion of TB is the key to early diagnosis and satisfactory outcomes in post-transplant TB.
结核病（TB）是实体器官移植的一种可能严重的并发症，与高死亡率和发病率相关。移植后 TB 的发病机制多种多样，有许多预防方法，这是降低其发病率的最重要途径。由于药物毒性和与免疫抑制剂的相互作用，器官受者中 TB 的治疗具有挑战性。
一名 18 岁女性，因接受已故供体的肾移植而出院，术后第 37 天因发热再次入院。CT 显示粟粒性 TB 迹象和除移植物瘘外的皮肤外的液体积聚。患者引流液中 BAAR 阳性，尿液中检出 Koch 杆菌。她接受了四种药物治疗方案（利福平、异烟肼、吡嗪酰胺和乙胺丁醇），反应良好，移植物功能得以保留。我们得知对侧肾脏的受者也发生了移植后 TB，提示供体来源。
TB 是实体器官移植后患者感染性并发症的重要鉴别诊断，特别是在流行地区。其初始临床表现可能不典型，发热或形成液体积聚时应怀疑 TB。对 TB 的怀疑是早期诊断和获得满意结局的关键。
