Su Qian, Xiao Jie, Peng Zhou, Zhou Liang, Wang Juan, Qiu Yingfeng
Hunan Chest Hospital, 519 Xianjiahu Road, Changsha, 410013, Hunan, China.
BMC Infect Dis. 2025 Jun 4;25(1):795. doi: 10.1186/s12879-025-11197-7.
The early clinical diagnosis of tuberculosis (TB) in kidney transplant recipients is difficult, and TB is one of the major infectious disease-related causes of morbidity and death in transplant recipients. This study analyzed the characteristics of patients who developed TB after renal transplantation in an effort to improve the diagnosis and treatment of such patients.
This retrospective study examined 100 patients who developed TB after kidney transplantation, and received treatment at the Hunan Chest Hospital from January 2014 to January 2024. The clinical characteristics of patients were examined, including general condition, date of TB onset, clinical manifestations, site of TB, immunological indicators, method of etiological detection, imaging findings, treatment, and outcome.
Secondary pulmonary TB was the most common diagnosis overall (n = 76), and abdominal TB was the most common type of extrapulmonary TB (n = 8). Eighty-eight patients were tested by the interferon-gamma release assay (IGRA); 72 (81.8%) had positive results, 13 (14.8%) had negative results, and 3 (3.4%) had uncertain results. Twenty-six patients received the tuberculin skin test (TST); 7 (26.9%) had positive results and 19 (73.1%) had negative results. The overall etiological detection rate was 58.0%. Analysis of factors associated with outcome showed that patients who received an intensive phase regimen of isoniazid + rifampicin + ethambutol + moxifloxacin were more likely to achieve cure than those who received an intensive phase regimen of isoniazid + rifampicin + ethambutol + pyrazinamide (P < 0.05).
Patients who develop TB after renal transplantation have atypical symptoms and imaging findings. In addition to conventional detection methods, the IGRA, TST, and invasive examinations may aid in diagnosis. An intensive-phase anti-TB regimen of isoniazid + rifampicin + ethambutol + moxifloxacin appeared to provide a better prognosis in these patients.
肾移植受者结核病（TB）的早期临床诊断困难，TB是移植受者发病和死亡的主要传染病相关原因之一。本研究分析了肾移植后发生TB的患者特征，以改善对此类患者的诊断和治疗。
这项回顾性研究检查了100例肾移植后发生TB并于2014年1月至2024年1月在湖南省胸科医院接受治疗的患者。检查了患者的临床特征，包括一般情况、TB发病日期、临床表现、TB部位、免疫指标、病因检测方法、影像学表现、治疗及结局。
继发性肺结核是总体上最常见的诊断（n = 76），腹部TB是肺外TB最常见的类型（n = 8）。88例患者接受了干扰素-γ释放试验（IGRA）检测；72例（81.8%）结果为阳性，13例（14.8%）结果为阴性，3例（3.4%）结果不确定。26例患者接受了结核菌素皮肤试验（TST）；7例（26.9%）结果为阳性，19例（73.1%）结果为阴性。总体病因检测率为58.0%。对与结局相关因素的分析表明，接受异烟肼+利福平+乙胺丁醇+莫西沙星强化期方案治疗的患者比接受异烟肼+利福平+乙胺丁醇+吡嗪酰胺强化期方案治疗的患者更有可能治愈（P < 0.05）。
肾移植后发生TB的患者有非典型症状和影像学表现。除传统检测方法外，IGRA、TST和侵入性检查可能有助于诊断。异烟肼+利福平+乙胺丁醇+莫西沙星强化期抗结核方案似乎能为这些患者提供更好的预后。
