Tuberculosis in solid organ transplant recipients at a tertiary hospital in the last 20 years in Barcelona, Spain.
OBJECTIVE
Mycobacterium tuberculosis (TB) is a serious opportunistic infection in solid organ transplant recipients. The TB incidence is 20 to 74 times greater than that among the general population. Our aim was to determine the incidence as well as the clinical, radiological, and microbiological features and outcomes of TB in these patients.


METHODS
We reviewed the clinical records of subjects with posttransplant TB from January 1988 to December 2007. A definite TB case was defined by a positive culture; probable TB by a positive smear or histological finding; and disseminated TB when 2 organs were involved. We noted an early diagnosis as ones in the first year posttransplantation. Outcomes were classified following the WHO recommendation and mortality related defined by death during treatment.


RESULTS
Among 4634 recipients (2757 kidney, 1334 liver, 361 double kidney-pancreas, and 182 heart), 21 (0.45%) developed posttransplant TB: namely, 0.47%, 0.22%, 1.1%, and 0.54%, respectively. In 2 cases M. tuberculosis did not grow upon culture; the diagnosis was established by positive acid-fast bacilli on a sputum smear or by histological findings on biopsy. The mean posttransplantation time to TB diagnosis was 21 months (48% early TB). Two patients had a previous history of TB. Fever was the most common symptom (71%). Pulmonary tuberculosis represented 47.6% of cases; extrapulmonary, 28.6%; and disseminated, 23.8%. Among the cases of pulmonary TB, 60% had unilateral infiltrates and 10% cavitations on X ray. Eighteen patients completed treatment. Five patients displayed adverse events, 3 of which were liver toxicity. Four patients died, with 3 deaths related to TB.


CONCLUSIONS
The incidence of TB in this cohort was higher than that among the general population (450 cases/100,000 recipients). TB was associated with adverse effects of treatment and significant mortality.
García-Goez
J F
JF
Service of Infectious Diseases, Hospital Clinic, Barcelona-IDIBAPS-University of Barcelona, Barcelona, Spain.
Linares
L
L
Benito
N
N
Cervera
C
C
Cofán
F
F
Ricart
M J
MJ
Navasa
M
M
Pérez-Villa
F
F
González
J
J
Moreno
A
A
D000328:Adult; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D016377:Organ Transplantation / Q000009:adverse effects*; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000821:virology; D013030:Spain; D015996:Survival Rate; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality