신이식후 발생한 결핵에 대한 고찰

Abstract

Clinical manifestations of tuberculosis are variable in renal transplant patients. Early detection of tuberculosis in renal transplant patients is very important for adequate management. We studied the incidence, clinical manifestations and the efficacy of treatment of tuberculosis in cyclosporine treated renal transplant recipients over the past 10 years. Between Feb. 1984 and Dec. 1994, we carried out 304 renal transplants in 300 patients at the Keimyung University Hospital. Tuberculosis was diagnosed in 14 patients after transplantation, an incidence of 4.6 per cent. All patients had been diagnosed luberculosis for an average 22.6±16.9(2~58) months after transplantation. Fever with chills was the most common presenting symptoms(64.3%) and other symptoms included cough, dyspnea and chest pain. Two patients had no subjective symptoms. Clinical manifestations include pulmonary tuberculosis in 6 patients(42.9%), extrapulmonary lesions in 7 patients(50%). The smear was posilive for acid-fast bacilli in 11 of 14 patients. Cultures from these patients grew M. tuberculosis. Two patients had a positive nested polymerase chain reaction results for M. tuberculosis. Combinations of antituberculous therapy rcgitnens were includi'd isoniazid, ethambutol, rifampicin with or without pyrazinamide. Two patients had failure ot' antitubrrciilous therapy. These patients were died, at 4 to 6 weeks after antituberculous therapy started Twelve patients were treated for 4~12 months. All of these palients achived complete remission. Six patients developed allograft kidney failure due to chronic rejection. We suggested that comprehensive search tor tuberculosis is important in cyclosporine-treated reanl transplant patient due to difficulties of early diagnosis and prevalent of extrapulmonary manifestations.