Influence of Cytoimmunological State on the Development of Tuberculosis in Heart Transplant Recipients

Abstract

We examined the relationship between the development of tuberculosis and the cytoimmunological state of orthotopic heart transplant (HTx) recipients, which is affected by immunosuppressive therapy. Tuberculosis developed in 7 (1%) of 716 HTx recipients (four men and three women, aged 33–71 years) during a 7-year period, the standardized annualizing rate being about 1 370/100 000 per year, which is greater than the 17.5/100 000 per year in the general population of Germany. Tuberculosis developed in the early posttransplant period in four patients when they were experiencing episodes of ongoing rejection, after 2.5, 3.5, 4.0, and 9.0 months, respectively, the standardized annualizing rate being 780/100 000 per year. In three of those four patients, cytoimmunological monitoring was carried out until the development of tuberculosis. The repeated administration of pulsed corticosteroid therapy followed by oral steroids reduced T-cell and CD4+ T-cell counts, which could have increased the risk of tuberculosis developing if they were exposed. The cytoimmunological state of the remaining three patients in whom tuberculosis developed late after HTx, when episodes of ongoing rejection did not exist, was similar to the preoperative state, the standardized annualizing rate being 590/100 000 per year. These findings indicate that the relatively high incidence of tuberculosis in post-HTx patients could be attributable to the immunosuppressive therapy given, including steroids.