title: Tuberculosis in lung transplant recipients.
abstract: BACKGROUND
  Post-lung transplant infection is one of the leading causes of morbidity and mortality. The cause and incidence are similar in many series; however, infections such as Mycobacterium tuberculosis are influenced by the epidemiologic situation. The authors present a prospective and observational study to define the incidence, clinical presentation, and course of tuberculosis in a cohort of lung transplant patients at a single center in Spain.
  
  
  METHODS
  Between 1990 and 2002, cutaneous delayed-type hypersensitivity testing and pathologic and microbiologic study of explanted lungs were conducted in 187 lung transplant patients. Serial bronchoscopies with transbronchial biopsy and bronchioalveolar lavage were performed during follow-up. The diagnosis of tuberculosis was established only when M. tuberculosis was identified in any sample or when histopathologic study was conclusive.
  
  
  RESULTS
  Forty-eight patients were classified as anergic (25.6%) and 61 (32.6%) were classified as having a positive tuberculin skin test. Of the 109 patients, 95 received latent tuberculosis infection prophylaxis. Tuberculosis was diagnosed in 12 patients (6.41%); in six of them, diagnosis was determined from the explanted lungs. The remainder were diagnosed during follow-up. Fever and dyspnea were the most common symptoms. Chest radiographic findings presented an alveolar pattern. All patients responded well to antituberculous therapy; no deaths were attributable to tuberculosis.
  
  
  CONCLUSIONS
  In the authors' experience, tuberculosis is not rare in lung transplant patients and can be managed successfully with antituberculous therapy without rifampin. A systematic protocol for diagnosing tuberculosis of the explanted lung is useful for reducing tuberculous complications of the implanted lung.
authors.affiliation: Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. cbravo@vhebron.net
authors.forename: Carlos
authors.initials: C
authors.lastname: Bravo
authors.forename: Juan
authors.initials: J
authors.lastname: Roldán
authors.forename: Antonio
authors.initials: A
authors.lastname: Roman
authors.forename: Javier
authors.initials: J
authors.lastname: Degracia
authors.forename: Joaquim
authors.initials: J
authors.lastname: Majo
authors.forename: Javier
authors.initials: J
authors.lastname: Guerra
authors.forename: Víctor
authors.initials: V
authors.lastname: Monforte
authors.forename: Rafael
authors.initials: R
authors.lastname: Vidal
authors.forename: Ferran
authors.initials: F
authors.lastname: Morell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000209:etiology*