Mycobacterial infections in renal allograft recipients.

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.