Avtor/Urednik		Aleš, A; Koselj, M; Kandus, A; Bren, AF
Naslov		Tuberkuloza pri bolnikih s tansplantirano ledvico
Tip		članek
Vir		In: Lindič J, Kaplan-Pavlovčič S, editors. Zbornik prispevkov 1. slovenski nefrološki kongres z mednarodno udeležbo; 1996 okt 23-26; Portorož. Ljubljana: Klinični center, Nefrološka klinika,
Leto izdaje		2000
Obseg		str. 224-9
Jezik		slo
Abstrakt		From 1970 to 1995 a total of 251 renal transplantations were performed at Ljubljana University Medical Center. Seven of 251 renal transplant patients, aged from 27 to 45 years developed tuberculosis (TBC) 2 to 88 month after successful renal transplantation (TX) - prevalence 2.7%. The standard immunosuppressive drugs, prednisolone and azathioprine (Aza), were used until 1984. Since then, low - dose prednisolone (Pr) and cyclosporine (CyA) were used. All patients had normal chest X-ray findings before TX, without evidence of history of antecedent TBC infection. Diagnosis of TBC was confirmed 14 to 88 days after the first clinical signs. Risk factors- hypoalbuminemia and neutropenia - had 2 our patients. In all our patients Mycobacterium tuberculosis was isolated from cultures. Isolated pulmonary TBC was present in 4 patients, miliary form in 2 and in 1 patient TBC of thoracic spine was found. The treatment protocol in the posttransplant TBC was the same as in the normal host: combination of Isoniazid, Rifampicin, Ethambutol of Pirazinamide for 6 - 9 month, in doses adjusted to the level of allograft function. The course in 2 patients with miliary TBC was rapidly progressive and both patients died. In 2 cyclosporine - treated patients there came to acute graft rejection, because of the interaction between Rifampicin and CyA. Allograft in 1 patient was lost. Three other patients were treated without complications. At the end of treatment 4 patients had a good transplant function. There were no recurrence of TBC in our Center. TBC after renal transplantation seems to be a serious clinical problem, especially when there is a delay in diagnosis and treatment. Treatment of TBC is even more complicated, when it comes to acute cellular rejection of the graft due to interaction between CyA and rifampicin.
Deskriptorji		KIDNEY TRANSPLANTATION TUBERCULOSIS TUBERCULOSIS, MILIARY PREDNISOLONE CYCLOSPORINE AZATHIOPRINE