title: Orthotopic liver transplantation for subacute hepatic failure following partial treatment of isoniazid-resistant tuberculosis.
abstract: The management of patients with pre-existing tuberculosis (TB) undergoing liver transplantation is challenging. Cautious immunosuppression is required to prevent reactivation of disease, and second-line anti-tuberculous treatment may be necessary to prevent graft hepatotoxicity. Furthermore, liver transplantation in the context of isoniazid-resistant TB has seldom been reported. We report on a 44-year-old man with recent isoniazid-resistant extra-pulmonary TB who developed subacute hepatic failure requiring emergency liver transplantation and treatment with second-line anti-tuberculous therapy. We demonstrate that patients who have pre-existing TB can be successfully treated with alternative anti-tuberculous medication while under immunosuppression post transplantation. Pre-existing TB, including resistant strains, should not be an absolute contraindication to liver transplantation.
authors.affiliation: Hepatobiliary and Transplant Unit, Cambridge University Teaching Hospitals NHS Trust, Addenbrookes's Hospital, Cambridge, UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Nash
authors.forename: T M
authors.initials: TM
authors.lastname: Yeung
authors.forename: P J
authors.initials: PJ
authors.lastname: Lehner
authors.forename: P
authors.initials: P
authors.lastname: Gibbs
authors.forename: W J H
authors.initials: WJ
authors.lastname: Griffiths
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid