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 duration from transplantation to diagnosis of tuberculosis was 31 months. The cumulative incidence of posttransplantation tuberculosis was 2.0% (15/ 760), ie, 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 posttransplantation tuberculosis patients without recurrence. KEY INDEXING TERMS : Solid organ transplantation; Tuberculosis; Post- transplantation tuberculosis. [Am J Med Sci 2007;334(2):106–110.