Mycobacterial infections in renal allograft recipients
R. K. Spence, D. C. Dafoe, G. Rabin, R. A. Grossman, A. Naji, C. F. Barker and L. J. Perloff
Primary mycobacterial infections developed in five of 565 patients who had
transplants during a 15-year period. All had negative PPDs and normal chest
roentgenograms; none had tuberculosis before transplantation. Atypical
mycobacteria were cultured in three of five infections. All were treated
with a multiple-drug regimen, including isoniazid, rifampin, ethambutol,
and streptomycin sulfate. In four of five patients, there were serious
drug-related complications. No major initial alteration of
immunosuppressive therapy was necessary in any of the patients. During the
study, a treatment policy was followed that included one year of isoniazid
treatment of all recipients with a positive PPD, history of tuberculosis,
chest x-ray film suggestive of tuberculosis, or PPD-positive donor. An
additional 14 transplant recipients were treated in accordance with this
policy without complications or subsequent mycobacterial infections
(32-month average follow-up). Despite the low incidence of mycobacterial
infection in this series, the potential lethality and morbidity mandate
constant vigilance.
