Clinical features and outcome of tuberculosis in solid-organ transplant recipients
Abstract number: P1780
Fernàndez-Sabé N., Lladó L., Gil-Vernet S., Alcaide F., Santín M., Carratalà J.
Objectives: The aim of this study was to analyze the frequency, characteristics, treatment and outcome of tuberculosis in solid-organ transplant (SOT) recipients.
Methods: We retrospectively reviewed medical charts of all cases of tuberculosis occcurring in SOT recipients from 2000 to 2007. Data regarding baseline and clinical features, treatment and outcome were retrieved.
Results: A total of 13 of 1304 SOT recipients developed tuberculosis (1%). The frequency of tuberculosis according to the type of allograft was 1.3% (9 of 700) for kidney recipients, 0.8% (4 of 485) for liver recipients, and 0% (0 of 119) for heart recipients. Eight patients were males (61%) and the mean age was 55 years (range, 3574 years). Seven patients were receiving more than one immunosuppressive drug by the time of diagnosis: corticosteroids (6), cyclosporine (5), mycophenolate mofetil (7), sirolimus (2) and tacrolimus (4). The mean time to the development of tuberculosis was 1726 days (range, 574131 days). Four patients (31%) developed tuberculosis within the first year post-transplantation. The mean duration of symptoms until diagnosis was 30 days (range, 1180 days). Seven patients (54%) had pulmonary tuberculosis, 4 (31%) had disseminated infection and 2 patients (15%) had lymph nodes involvement. One patient had concomitant cytomegalovirus infection. No Mycobacterium tuberculosis strain was resistant to first-line antituberculous drugs. All patients were given isoniazid, and most of them received a 3-drug regimen. Rifampin was used in 9 cases. Six patients (4 liver and 2 renal recipients) developed hepatotoxicity, leading to discontinuation of antituberculous treatment in 4 cases. One patient developed rejection during treatment without allograft lost. Overall mortality was 15% (2 of 13 patients).
Conclusions: In this study, 1% of SOT recipients developed tuberculosis, which frequently presented with extra-pulmonary involvement and caused considerable mortality. Hepatotoxicity was a significant therapeutic drawback, mainly among liver transplant recipients.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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