Clinical features and outcome of tuberculosis in solid organ transplant recipients.
BACKGROUND
: Taiwan is an area with moderate to high incidence of Mycobacterium tuberculosis infection. The risk of M tuberculosis infection in transplantation recipients is considered to be significant. Our aim in this study was to investigate the clinical spectrums of M tuberculosis-infected transplantation recipients in a southeast Asian country, Taiwan.


METHODS
: We retrospectively analyzed the demographic data, clinical features, treatment, and outcome of M tuberculosis infection in kidney, heart, and liver transplant recipients from May 1996 to April 2005 at the National Taiwan University Hospital.


RESULTS
: Fifteen patients who had received solid organ transplantation developed tuberculosis (kidney = 6, heart = 7, liver = 2). The median duration from transplantation to diagnosis of tuberculosis was 31 months. The cumulative incidence of post-transplantation tuberculosis was 2.0% (15/760), ie, approximately 3 times that of the general population. Ten patients (66.7%) had pulmonary tuberculosis, 1 (6.7%) had extrapulmonary tuberculosis, and 4 (26.7%) had disseminated tuberculosis. Nine patients completed the anti-tuberculosis treatment; the median treatment duration was 12 months (pulmonary: 9 months; extrapulmonary: 13.5 months). No treatment failure was noted in patients receiving the complete treatment course. The graft failure and mortality rates of post-transplantation tuberculosis were 13.3% each (2/15). The tuberculosis-associated mortality rate was 6.7% (1/15).


CONCLUSIONS
: Cumulative incidence of tuberculosis was slightly higher in transplant recipients than in the general population in Taiwan. Conventional 4-combined anti-tuberculosis regimen for 12 months can treat the potentially fatal infection successfully in post-transplantation tuberculosis patients without recurrence.
Hsu
Meng-Shiuan
MS
Far Eastern Memorial Hospital, Taipei, Taiwan.
Wang
Jiun-Ling
JL
Ko
Wen-Je
WJ
Lee
Po-Huang
PH
Chou
Nai-Kwan
NK
Wang
Shoei-Shen
SS
Chu
Shu-Hsun
SH
Chang
Shan-Chwen
SC
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D016572:Cyclosporine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006304:Health Status; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D009894:Opportunistic Infections / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D016377:Organ Transplantation / Q000009:adverse effects*; D016559:Tacrolimus / Q000097:blood; D016896:Treatment Outcome; D014376:Tuberculosis / Q000097:blood / Q000188:drug therapy / Q000209:etiology*
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus