TUBERCULOSIS IN HEART-TRANSPLANT RECIPIENTS

We present an analysis of the incidence, clinical presentation, and ev olution of tuberculosis in heart transplant recipients at a 2,200-bed tertiary care center in Madrid and review the world literature. During a 5-year period (1989-1993), active extrapulmonary tuberculosis was d iagnosed in three of the 144 patients who survived heart transplantati on, resulting in an incidence of 1.35 cases per 100 heart transplant-y ears (> 20-fold the national average). The mean age of the patients wa s 52 years, and two were male. The mean time to development of tubercu losis after transplantation was 76 days (range, 55-102 days). All of t he patients had had previous episodes of rejection and infection and h ad had initially negative tuberculin tests (one converted to positive during therapy). Clinical manifestations were mild or absent in two of the patients, and Mycobacterium tuberculosis was isolated in associat ion with other microorganisms from two patients. All patients were suc cessfully treated with antituberculous chemotherapy while they were re ceiving immunosuppressants. A severe drug interaction between cyclospo rine and rifampin in the first case necessitated withdrawal of rifampi n and precluded its use in subsequent patients. During a mean follow-u p of 2 years, no recurrence of tuberculosis has been detected in any o f the patients. Tuberculosis was diagnosed in a fourth patient before transplantation, which was performed while the patient was receiving a ntituberculous therapy. Our data support the conclusion that heart tra nsplantation should be considered an unheralded risk factor for tuberc ulosis, particularly in countries where this disease is prevalent.