Mycobacterium tuberculosis - Associated immune reconstitution syndrome in solid-organ transplant recipients
Journal
Transplantation
Journal Volume
95
Journal Issue
9
Pages
1173-1181
Date Issued
2013
Author(s)
Munoz P.
Torre-Cisneros J.
Aguado J.M.
Lattes R.
Montejo M.
Garcia-Reyne A.
Bouza E.
Valerio M.
Lara R.
John G.T.
Bruno D.
Singh N.
Abstract
BACKGROUND: Incidence, characteristics, and risk factors for tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (IRS) in solid-organ transplant (SOT) recipients are not known. METHODS: Patients are composed of 64 consecutive SOT recipients with TB followed for 12 months. IRS was defined based on previously proposed criteria. RESULTS: IRS developed in 14% (9/64) of the patients, a median of 47 days after the use of anti-TB therapy. Liver versus other types of organ transplant recipients (adjusted odds ratio [OR], 6.11; 95% confidence interval [CI], 1.08-34.86), prior cytomegalovirus infection (adjusted OR, 5.65; 95% CI, 0.93-34.47), and rifampin use (adjusted OR, 4.56; 95% CI, 0.74-27) were associated with a higher risk of IRS. The presence of more than one factor (liver transplantation, cytomegalovirus infection, and rifampin use) when compared with none of these factors conferred a 19-fold increase in the risk of IRS (P=0.01). Mortality at 1 year after diagnosis was 33.3% in patients with IRS and 17.2% in those without IRS (P=0.31). CONCLUSIONS: IRS was documented in 14% of the SOT recipients with TB. We determined clinically identifiable factors that may be useful in assessing the risk of tuberculosis-associated posttransplantation IRS. Copyright ? 2013 Lippincott Williams & Wilkins.
SDGs
Other Subjects
azathioprine; calcineurin inhibitor; cyclosporin; ethambutol; isoniazid; mycophenolic acid 2 morpholinoethyl ester; prednisone; pyrazinamide; rifampicin; tacrolimus; adult; aged; article; controlled study; cytomegalovirus infection; disease association; drug dose reduction; drug efficacy; drug safety; drug withdrawal; female; graft rejection; histopathology; human; human tissue; immune reconstitution inflammatory syndrome; immunosuppressive treatment; incidence; kidney transplantation; liver transplantation; lung transplantation; major clinical study; male; Mycobacterium tuberculosis; organ transplantation; priority journal; risk assessment; risk factor; tuberculosis; Humans; Immune Reconstitution Inflammatory Syndrome; Immunosuppression; Logistic Models; Organ Transplantation; Risk Factors; Tuberculosis
Type
journal article