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Single center experiences: characteristics of tuberculosis in iost-renal-transplant recipients during 20 years

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Author:
No author available
Journal Title:
Chinese Journal of Organ Transplantation
Issue:
10
DOI:
10.3760/cma.j.issn.0254-1785.2011.10.006
Key Word:
肾移植;结核;诊断;治疗;Kidney transplantation;Tuberculosis;Diagnosis;Therapy

Abstract: Objective To analyze the characteristics of tuberculosis (TB) in renal-transplant recipients from our hospital, and summarize the corresponding experiences in diagnosis and management.Methods A retrospective study was performed on 61 documented post-transplant TB cases out of the 2842 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University between Jan.1991 and Dec.2010.Results TB in the post-renal-transplant population in our hospital displayed the following characteristics:(1) High incidence (2.1% ).54.1% recipients were diagnosed within the first year post-transplant; (2) Lung was the most common site (77.0 %).There was high prevalence (60.7 %) of extra-pulmonary TB (lymphatic TB,23.0 %; pleuritis,13.1 %; graft,11.5%); (3) Fever (83.6 %),cough (55.7 %),sputum (41.0 %) were the most common clinical manifestations.There were also emaciation (3.3 %) and enlargement of lymph nodes (18.0 %); (4) Chest X-ray and CT were of great value during TB diagnosis while purified protein derivative of tuberculin (PPD) skin test had little diagnostic value with a negative result in 56 cases (91.8 %) ; (5) Liver function damage ( 16.4 %),kidney function injury (39.3 %) and peripheral nerve toxicity (3.3 %) were the main adverse reactions of anti-tuberculosis chemotherapy,also the major cause of anti-TB failure; (6) Pre-transplant TB (17 cases) increased the probability of TB recurrence (4 cases,23.5 %) post-transplantation; (7) The post-transplant TB patients were accompanied with cellular immune deficiency,resulting in overlapping infection of bacteria,viruses and fungi (19.7 %); (8) 1- and 3-year patient/graft survival rate of patients with post-transplant TB was 85.2 %/78.7 % and 85.2 %/75.4 % respectively. The accumulative mortality rate reached to 14.8%,while overlapping infection was the major cause of death (66.7 %).Conclusion Chinese renal transplant recipients still face a high risk of TB because of their immunecompromised state and epidemiological prevalence of the disease. For the high mortality rate and associated serious complications,rapid diagnosis and effective anti-TB chemotherapy are of great value for TB population.

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