PULMONARY TUBERCULOSIS AFTER LUNG TRANSPLANTATION

During a 5-year study period, we diagnosed pulmonary tuberculosis in t wo (2%) of 94 lung and heart-lung transplant recipients. Each infectio n occurred 3 months after bilateral lung transplantation in the presen ce of evidence implicating donor-to-recipient transmission of the path ogen. The radiographic patterns of pulmonary tuberculosis were subtle: narrowing of the middle lobe bronchus of the right lung caused by an endobronchial granulomatous mass (n=1) and a focal cluster of small no dules in the upper lobe of the left lung and small bilateral pleural e ffusions (n=1). Each patient achieved complete clinical and radiograph ic response after antituberculous therapy. We conclude that Mycobacter ium tuberculosis may be transmitted directly by a donor lung and may i nvolve bronchial mucosa, pulmonary parenchyma, and pleura.