Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Characteristics of Tuberculosis in Liver or Heart Transplant Recipients

간 또는 심장이식을 시행 받은 환자에서의 결핵의 발생률 및 임상양상

  • Jung, Hoon (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Oh, Yeon-Mok (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Lee, Sang-Do (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Woo-Sung (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Dong-Soon (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Won-Dong (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Kim, Jae-Joong (Division of Cardiology, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine) ;
  • Lee, Sung-Gyu (Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Asan Medical Center, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae-Sun (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine)
  • 정훈 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김재중 (울산대학교 의과대학 서울아산병원 심장내과) ;
  • 이승규 (울산대학교 의과대학 서울아산병원 외과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2006.09.18
  • Accepted : 2006.10.18
  • Published : 2006.11.30
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Abstract

Background: Post-transplant tuberculosis (TB) is a serious complication in solid organ transplant recipients worldwide, However there is little or no data on TB in liver or heart transplant recipients in Korea. Methods: The incidence and clinical characteristics of TB of 730 patients who had undergone a liver transplant in a university hospital in Korea between 1992 and 2004, and 110 heart transplant recipients in the same period, were reviewed retrospectively. Results: The incidence of TB was 1.5%(11/730) and 2.7%(3/110) in the liver and heart transplantation, respectively. The median time from the transplant to the development of TB was 8.4 months(1.0-30.8). and the mean time from the symptoms to the diagnosis of TB was $2.1{\pm}3.6$ months(0.3-13.2). Nine patients (65%) had pulmonary TB and five (35%) had extrapulmonary TB. The leukopenia and positive HbeAg at the baseline, post-transplant diabetes mellitus, and chronic rejection were associated with the development of TB in the liver transplant recipients. Ten patients were treated with a 4-drug standard regimen for a mean duration of $7.8{\pm}3.5$ months. One patients died of TB. Conclusion: The incidence of TB in liver or heart transplant recipients was similar to that reported in other countries with a similar TB-burden.

연구배경: 감염증의 발생여부는 장기이식환자의 예후에 중요한 영향을 미친다. 국내와 같이 결핵의 유병률이 높은 지역에서는 장기이식후 기회감염으로 결핵 발병의 위험성이 높을 것으로 추정되나 아직 간 또는 심장이식환자에서의 결핵의 발병률 및 임상양상에 대한 보고가 부족하거나 없다. 방 법: 1992년 1월 부터 2004년 7월까지 서울아산병원에서 간 또는 심장이식을 받은 840명(간이식 730 예, 심장이식 110예)을 대상으로 의무기록을 후향적으로 분석하였다. 결 과: 국내의 한 대학병원에서 간이식 후 결핵의 발생률은 1.5% (추적 $26.6{\pm}19.8$개월), 심장이식은 2.7% (추적 $59.7{\pm}33.3$개월)였다. 이것은 과거 보고된 국내 신장이식 환자들에서의 결핵 유병률보다는 낮은 것으로 추정된다. 폐외결핵이 35% (속립성 결핵 14%)를 차지하여 기존의 보고들과 같이 폐외결핵의 발병률이 높았다. 간이식 환자에서 결핵발병의 위험인자는 단변수 분석에서 이식 후 당뇨, 낮은 이식 전 백혈구 수치, 만성거부반응이었고, HBeAg 양성은 경계수준의 유의성을 보였다. 대부분의 이식환자에서 결핵 예방 치료가 시행되지 않았고, 결핵이 발생한 대다수의 환자는 리팜핀을 포함한 1차 약제로 치료하였고, 항결핵치료와 연관된 급성 거부반응은 2예에서 관찰되었다. 결 론: 국내의 한 대학병원에서 간 또는 심장이식 후 결핵의 발생률은 각각 1.5%, 2.7%로 결핵의 유병률이 낮은 국가에서의 이식 후 결핵 발병률 보다 높았으며 폐외결핵이 많았다.

Keywords

References

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