MYCOBACTERIUM-TUBERCULOSIS INFECTION IN SOLID-ORGAN TRANSPLANT RECIPIENTS - IMPACT AND IMPLICATIONS FOR MANAGEMENT

Tuberculosis is a serious opportunistic infection in transplant recipi ents. On the basis of the compilation of published reports in the lite rature, the incidence of Mycobacterium tuberculosis infection in organ transplant recipients worldwide ranged from 0.35% to 15%. Nonrenal tr ansplantation (P = .004), rejection within 6 months before the onset o f tuberculosis (P = .02) and type of primary immunosuppressive regimen (P = .007) were predictors of M. tuberculosis infection occurring wit hin 12 months after transplantation. Thirty-three percent (155) of 476 transplant patients with tuberculosis had disseminated infection; rec eipt of OKT3 or anti-T cell antibodies (P = .005) was a significant pr edictor of disseminated tuberculosis. Overall, the mortality rate amon g 499 patients was 29%; disseminated infection (P = .0003), prior reje ction (P = .006), and receipt of OKT3 or anti-T cell antibodies (P = . 0013) were significant predictors of mortality in patients with tuberc ulosis. Clinically significant hepatotoxicity due to isoniazid occurre d in 2.5%, 4.5%, and 41% of renal, heart and lung, and liver transplan t recipients, respectively. The diagnosis and effective management of tuberculosis after transplantation warrant recognition of the unique e pidemiological and clinical characteristics of tuberculosis in transpl ant recipients.