신장 이식후 발생한 결핵에 관한 고찰

Abstract

Purpose: Transplant recipients under maintenance immunosuppression are likely to be exposed to mycobacterial infection that is associated with increased morbidity and mortality.

Methods: This review is based on the clinical data of 103 post-transplant tuberculosis recipients from the 1863 renal allograft recipients database between 1984 and 1999. Kinds of immunosuppression, history of acute rejection, use of anti-lymphocyte antibody, age and sex of recipient, presence of diabetes, presence of hepatitis B antigen pre- transplant, and history of pre-transplant tuberculosis were considered as potential risk factors for the development of post-transplant method and Cox proportional hazard model were used for the analyses.

Results: During 80 months of mean follow-up period, a total of 103 recipients were found to have tuberculosis (80 males and 23 females, mean age was 39.95+/-11.85 years old). Mean time interval from transplant to diagnosis of tuberculosis was 46+/-34.3 months. Cumulative incidence of tuberculosis post-transplant 5 and 10 year was 4.73 and nd culture for AFB, AFB-PCR, adenosine deaminase test, bronchoalveolar 7.76%, respectively, which were higher than that of the overall Korean population (0.8% in 1995). We a lavage and tissue biopsy (closed or bron-choscopic), and pleural tapping with biopsy. The treatment protocol was not different with regimens for general population. Duration of treatment differed from the clinical improvement (mean duration was 10.5 months). The pulmonary infection (including pleural effusion) was most common form of infection (n=71, 68.9%). Extra-pulmonary infection (including miliary tuberculosis) was 31.1% (n=32), which was higher than that of tuberculosis in Korean population (25% in 1998). In Cox regression analysis, previous history of tuberculosis was the strongest risk factor affecting the development of tuberculosis. Use of azathioprine-steroids or use of anti-lymphocyte antibody was also found to be a significant risk factor, respectively. Ten-year patient/graft survival rate in recipients with extra- pulmonary infection was 60.4/48.9, which was significantly inferior compared with those among the tuberculosis-free recipients (84.7/69.4%), or patients with tuberculosis limited to lung and pleura (81.1% and 56.6%). These differences were statistically significant (P<0.05, respectively).

Conclusion: Taking considering that the pre-transplant tuberculosis history was strongest risk factor of post-transplant tuberculosis, strategy on the prophylaxis for tuberculosis should be planned.