Mycobacterium tuberculosis infection in pediatric liver transplant recipients.
OBJECTIVE
To study the incidence, clinical presentation, management, complications and outcome of tuberculosis in pediatric liver transplant recipients.


METHODS
A retrospective review of the medical records of children who underwent liver transplantation between 1991 and 1998.


RESULTS
Mycobacterium tuberculosis infection occurred in 6 of 254 (2.4%) children undergoing liver transplantation between 1991 and 1998. Cough, pyrexia and poor appetite were common presentations; one-half had normal chest radiographs. The median time to confirmation of diagnosis was 8 months (range, 1 to 17 months). Tests contributing to diagnosis included: Ziehl-Neelsen (ZN) stain (2 patients), M. tuberculosis polymerase chain reaction (1 patient), Mantoux test (1 patient) and histopathology (4 patients). Family health screening was productive for 4 patients. Duration of treatment varied from 9 to 18 months. Isoniazid-induced hepatitis was observed in 2 patients but resolved with dose reduction. Two patients died while receiving treatment, one of Klebsiella spp. septicemia and the other of pulmonary hemorrhage.


CONCLUSIONS
Tuberculosis after liver transplantation has a significant morbidity and mortality. Pretransplantation a personal and family history of tuberculosis must be sought, and screening of patients and their families should be considered. Standard regimens incorporating isoniazid and rifampin are effective, but regular monitoring of liver function is essential to detect drug-induced hepatotoxicity.
Dulwich Public Health Laboratory and Medical Microbiology, King's College Hospital, London, UK. anil.dhawan@kcl.ac.uk
A
A
Verma
A
A
Dhawan
J J
JJ
Wade
W H
WH
Lim
G
G
Ruiz
J F
JF
Price
N
N
Hadzic
A J
AJ
Baker
M
M
Rela
N D
ND
Heaton
G
G
Mieli-Vergani
D000293:Adolescent; D000995:Antitubercular Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D002675:Child, Preschool; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007538:Isoniazid / Q000009:adverse effects; D016031:Liver Transplantation; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D013194:Staining and Labeling; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology
D000995:Antitubercular Agents; D007538:Isoniazid