Tuberculosis in liver transplant recipients: a single Brazilian center experience.
BACKGROUND
Tuberculosis (TB) is an important opportunistic infection in transplant recipients worldwide. The frequency of Mycobacterium tuberculosis disease varies among different regions, but the incidence of TB in adult liver transplant (LT) recipients is largely unknown. The estimated frequency ranges from 0.7% to 2.3%, with mortality rate up to 30%. However, these data are based on individual case reports or series with small samples. In LT recipients, therapy is generally associated with significant hepatotoxicity and interactions with immunosuppressive drugs.


METHODS
This retrospective analysis included 319 patients who underwent LT at University Hospital, Federal University of Minas Gerais, Brazil, between September 1994 and July 2007 and survived more than 1 month. Among these, TB was diagnosed in five patients. No patients received chemoprophylaxis before or after LT.


RESULTS
All five patients were women, mean age 39.6+/-16.5 years. Two patients had disseminated TB, two pulmonary involvement, and one extrapulmonary disease. Cultures were positive in four patients. Overall, four patients received isoniazid, rifampin, and pyrazinamide for 6 to 12 months, with good tolerance, but one patient presented recurrence. Another patient presented raised hepatic enzymes levels after initiating therapy. All patients are alive and well.


CONCLUSIONS
In this series, the TB frequency after liver transplantation was 1.57%, with no confirmed hepatotoxicity with conventional treatment and an excellent survival rate (100%).
Clemente
Wanessa T
WT
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil. wanclemente@yahoo.com.br
Faria
Luciana C
LC
Lima
Stella S S
SS
Vilela
Eduardo G
EG
Lima
Agnaldo S
AS
Velloso
Luiz F
LF
Sanches
Marcelo D
MD
Cançado
Omar L
OL
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012882:Skin Tests; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D055815:Young Adult
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents