| Objective:Tuberculosis is one of the most common opportunistic infections among kidney transplant recipients, and is related to high morbidity and mortality. This study aims to summarize the clinical characteristics of tuberculosis in kidney transplant recipients, in order to discuss the diagnosis and treatment of tuberculosis after kidney transplantation. Methods:We retrospectively analyzed the informations of kidney transplant recipients who were diagnosed as tuberculosis from March 2008 to March 2014 in PLA 309 hospital. The datas of each patient including age, gender, comorbidities, operation time, immunosuppressant therapy, occurring time of tuberculosis postoperation, clinical manifestation, tubercular screening tests, diagnosis methods, antitubercular therapeutic regimen, side effect of drugs, length of stay and prognosis were well recorded. Analysis and summarize the clinical characteristics of TB tuberculosis in kidney transplant recipients in order to provide a reference basis of diagnosis, treatment and prevention. We applied a software package, SPSS version 20.0, for statistical analysis. Results:(1) This study included 91 patients, the most of which are secondary pulmonary tuberculosis(73.6%, 67/91). The most rare of extrapulmonary tuberculosis is tuberculous pleurisy(19.8%, 18/91). Tuberculosis often occurred in 1-12 months after transplantation(28.6%, 26/91), after that, the number gradually reduce. Mortality was 4.4%(4/91), of which two tuberculous meningitis, the mortality rate of 100%.(2) Clinical manifestations of tuberculosis patients after transplantation are usually atypical. The most common symptoms of 91 cases is fever(89.0% 81/91), in which the high fever(67.1% 61/91) based. Other symptoms include cough or sputum( 48.4% 44/91), fatigue( 2.2% 2/91), chest( 3.3% 3/91), chest pain( 4.4% 4/91), etc.(3)The lack of effective methods to diagnose tuberculosis after kidney transplantation. Pathogen detection rate was 50.6%(42/83), in which sputum smear(36.1% 30/83) is most effective method of detection. The patients who have negative result of sputum smear or miss statistics were diagnosed by CT most(71.4% 35/49). Diagnostic treatment(12.2% 6/49) is feasible in the patients who were suspected as TB without effective diagnostic method. IGRA(87.5% 21/24) has a higher sensitivity than the TST(53.3% 8/15)(P=0.03).(4)The main adverse reactions of antituberculosis treatment after kidney transplantation are high uric acid hematic disease(38.5%, 35/91), renal abnormalities(11.0%, 10/91), abnormal liver function(11.0%, 10/91), etc. Rifamycin can cause immune inhibitor concentration lower(P<0.01), but there were no obvious difference between Rifampin and Rifapentine(P=0.31). Conclusion:We used retrospective method to summarize 91 patients with tuberculosis after kidney transpiantation. The results appear as shown below: l. Tuberculosis often occurred in 1-12 months after transplantation. 2. The mortality of tuberculosis in kindey transplant recipients was 4.4%. The central nervous system tuberculosis mortality was 100%. 3. Secondary pulmonary tuberculosis was the most common infections. Tuberculous pleurisy was the most extrapulmonary tuberculosis. 4. The clinical manifestations are usually atypical. 5. The diagnosis methods of tuberculosis in kidney transplant recipients lack of sensitivity. Among the tuberculosis screening test, IGRA(Interferon-gamma release assays) is more sensitive than TST(Tuberculin skin tests)( P=0.03). 6. Rifamycin can affect blood concentrations of immunosuppressant. This study is aimed to provide evidence for the early diagnosis, reasonable therapeutic regimen and prophylaxis of tuberculosis after kidney transplantation. |
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