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Tuberculosis in lung transplant recipients.
Carlos Bravo1, Juan Roldán, Antonio Roman
1Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. cbravo@vhebron.net
Transplantation
|February 17, 2005
Summary
Tuberculosis is a significant risk in lung transplant recipients, with a 6.41% incidence observed. Early diagnosis and treatment of tuberculosis are crucial for successful management in these patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Transplant Surgery
Background:
- Post-lung transplant infection significantly impacts patient morbidity and mortality.
- Mycobacterium tuberculosis infections are influenced by local epidemiology.
- Lung transplant recipients are a vulnerable population for opportunistic infections.
Purpose of the Study:
- To determine the incidence of tuberculosis in lung transplant patients.
- To describe the clinical presentation and outcomes of tuberculosis post-lung transplant.
- To evaluate the effectiveness of diagnostic and therapeutic strategies for tuberculosis in this cohort.
Main Methods:
- Prospective observational study of 187 lung transplant patients (1990-2002).
- Inclusion of delayed-type hypersensitivity testing, explanted lung pathology, and serial bronchoscopies.
- Tuberculosis diagnosis confirmed by M. tuberculosis identification or conclusive histopathology.
Main Results:
- Tuberculosis diagnosed in 12 patients (6.41%) with fever and dyspnea as common symptoms.
- Alveolar pattern on chest radiographs observed in affected patients.
- All patients successfully treated with antituberculous therapy, with no tuberculosis-related deaths.
Conclusions:
- Tuberculosis is not uncommon in lung transplant recipients and is manageable.
- Antituberculous therapy, potentially excluding rifampin, can be effective.
- A systematic protocol for diagnosing tuberculosis in explanted lungs aids in preventing post-transplant complications.