Abstract：Objective To summarize and analyze the clinical features of mycobacterium tuberculosis (MTB) infection in liver transplant recipients.Methods The clinical data of 44 patients with post-transplant tuberculosis in the 8th Medical Center of PLA General Hospital from April 2009 to April 2021 were retrospectively reviewed, and the clinical manifestations, laboratory results,imaging features, treatment and prognosis were descriptively analyzed.Results The mean age of the patients was (53.95±9.15) years. The most frequently reported symptoms at diagnosis were fever(52.3%), followed by cough(50%) and expectoration(36.4%). The median time between liver transplant and TB diagnosis was 24(10.00,59.25) months, and 14 cases(31.8%) occurred during the first post-transplant year. Secondary pulmonary tuberculosis (68.2%)was the most common, and 27.3% patients had two or more tuberculosis types. The incidence of extra-pulmonary and disseminated tuberculosis was 25% and 15.9%, respectively. The positive rates of PPD test, blood tuberculosis antibody and interferon-gamma release assays are 47.4%,75%, 67.7% respectively. The positive rate of blood tuberculosis antibody was significantly higher than that of PPD test(χ2=4.39,P=0.04). 56.8% of the patients underwent invasive examination, and the positive rate was 92%. The number of people definitely diagnosed with invasive methods was significantly higher than that with non-invasive methods(χ2=15.14,P<0.01). 11 patients (25%)had impaired liver function throughout the course of treatment, and the total effective rate of treatment was 90.9%.Conclusions Tuberculosis is most common after liver transplantation within 2 years. Early diagnosis of tuberculosis after liver transplantation is difficult and the misdiagnosis rate is high, so more attention should be paid to tuberculosis in patients with recurrent pulmonary infection after liver transplantation. Suspected cases should receive diagnostic therapy timely, and invasive examination is helpful in diagnosis.
Abad C L R, Razonable R R. Mycobacterium tuberculosis after solid organ transplantation: A review of more than 2000 cases[J].Clin Transplant,2018,32(6):e13259.
[2]
Torre-Cisneros J, Doblas A, Aguado J M, et al. Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort[J].Clin Infect Dis,2009,48(12):1657-1665.
Zhao Y, Xu S, Wang L, et al. National survey of drug-resistant tuberculosis in China[J]. N Engl J Med,2012,366(23): 2161-2170.
[5]
Global tuberculosis report 2019. Geneva: World Health Organization, 2019[EB/OL].(2019-12-30)[2022-01-18]https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1
[6]
Bosch A, Valour F, Dumitrescu O,et al. A practical approach to tuberculosis diagnosis and treatment in liver transplant recipients in a low-prevalence area[J]. Med Mal Infect,2019,49(4): 231-240.
[7]
Leong L Y, Lin P C, Chi C Y, et al. Risk factors of tuberculosis after liver transplant in a tertiary care hospital[J]. J Microbiol Immunol Infect, 2021,54(2):312-318.
[8]
Mamishi S, Pourakbari B, Moradzadeh M,et al. Prevalence of active tuberculosis infection in transplant recipients: A systematic review and meta-analysis[J]. Microb Pathog,2020,139:103894.
[9]
Pennington K M, Kennedy C C, Chandra S, et al. Management and diagnosis of tuberculosis in solid organ transplant candidates and recipients: Expert survey and updated review[J]. J Clin Tuberc Other Mycobact Dis,2018,11:37-46.
Schuhmacher Neto R, Giacomelli IL, Schuller Nin C, et al. High-resolution CT findings of pulmonary tuberculosis in liver transplant patients[J]. Clin Radiol, 2017,72(10):899 e9- e14.
[13]
Carlesi E, Orlandi M, Mencarini J, et al. How radiology can help pulmonary tuberculosis diagnosis: analysis of 49 patients[J]. Radiol Med,2019,124(9):838-845.
[14]
Zumla A, Raviglione M, Hafner R, et al. Tuberculosis[J]. N Engl J Med,2013, 368(8): 745-755.
[15]
Getahun H, Matteelli A, Chaisson R E,et al. Latent Mycobacterium tuberculosis infection[J]. N Engl J Med,2015,372(22): 2127-2135.
[16]
Abad C L R, Razonable R R. Donor derived Mycobacterium tuberculosis infection after solid-organ transplantation: A comprehensive review [J]. Transpl Infect Dis, 2018,20(5):e12971.
[17]
Subramanian A K, Theodoropoulos N M. Infectious diseases community of practice of the american society of transplantation. Mycobacterium tuberculosis infections in solid organ transplantation: Guidelines from the infectious diseases community of practice of the American Society of Transplantation[J]. Clin Transplant,2019,33(9): e13513.
[18]
Abad C L R, Deziel P J, Razonable R R. Treatment of latent TB Infection and the risk of tuberculosis after solid organ transplantation: comprehensive review[J]. Transpl Infect Dis,2019, 21(6): e13178.
[19]
Horsburgh C R Jr, Barry C E 3rd, Lange C. Treatment of Tuberculosis[J]. N Engl J Med,2015,373(22): 2149-2160.
Lewinsohn D M, Leonard M K, LoBue P A, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children[J].Clin Infect Dis,2017,64(2):e1-e33.
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