Implications for management of Mycobacterium tuberculosis infection in adult-to-adult live donor liver transplantation.
BACKGROUND
Mycobacterium tuberculosis (TB) infection is a serious opportunistic infection especially in live donor liver transplantation (LDLT). Hepatotoxicity of antituberculous agents and hazardous drug interaction with immunosuppressants may render the graft more susceptible to injury.


OBJECTIVE
To review our experience of management of TB infection in liver transplant recipients including LDLT.


METHODS
A total of 397 liver transplantations were performed in the University of Hong Kong Medical Centre from January 1991 to December 2004. Eight patients (2.0%) developed TB infection after transplantation (LDLT: n=6, DDLT: n=2) and their clinical courses were reviewed.


RESULTS
The mean time of developing TB infection after liver transplantation was 9 months (range 4-20 months). Anti-TB treatment was administered for a mean duration of 12.7 months (11-18 months). None of our patients developed antituberculous drug-induced hepatotoxicity or had unwanted drug interaction. With a mean follow-up of 65 months (range 18-102 months), one patient died due to the recurrence of hepatocellular carcinoma.


CONCLUSIONS
High index of suspicion for TB infection should be warranted for a history of cough and fever after liver transplantation. No notable difference was observed in the natural history and management of TB infection between LDLT and DDLT. The use of antituberculous drugs is safe in liver transplant recipients provided that liver function is closely monitored and the dosage of immunosuppressants is adjusted accordingly.
Chan
Albert C Y
AC
Department of Surgery, Centre for the Study of Liver Disease, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Lo
Chung Mau
CM
Ng
Kelvin Kwok Chai
KK
Chan
See Ching
SC
Fan
Sheung Tat
ST
D000328:Adult; D000995:Antitubercular Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D009894:Opportunistic Infections / Q000517:prevention & control*; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents