Living-donor liver transplantation in patients with concurrent active tuberculosis at transplantation.
METHODS
Although active tuberculosis (TB) is a contraindication for liver transplantation (LT), LT may be the only possible treatment option in patients with irreversible liver failure and concurrent TB.


OBJECTIVE
To assess the outcome of LT in patients with concurrent TB and liver failure.


METHODS
We retrospectively evaluated the clinical outcomes of nine LT recipients with concurrent TB in Korea, an intermediate TB burden country.


RESULTS
The primary causes of living-donor LT (LDLT) in nine patients were anti-tuberculosis drug-induced fulminant hepatic failure (n = 4) and end-stage liver disease (n = 5). The sites of active TB were the lungs (n = 5), lymph nodes (n = 3) and pleura (n = 1). After LDLT, most patients were treated with less hepatotoxic drugs, including fluoroquinolones, ethambutol and cycloserine; none was treated with pyrazinamide. One patient experienced acute rejection, probably attributable to an interaction between rifampicin and cyclosporine. All nine patients, including one taking rifabutin, successfully completed anti-tuberculosis treatment and have been followed up for a median of 926 days after LDLT, without relapse of TB.


CONCLUSIONS
When properly managed, the prognosis of LDLT recipients with concurrently active TB at transplantation is very favourable. The current protocol, which considers active TB an absolute contraindication for LT, should be modified or relaxed, particularly for patients with LDLT.
Lee
Y T
YT
Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hwang
S
S
Lee
S-G
SG
Kim
K-W
KW
Choi
N-K
NK
Park
G-C
GC
Yu
Y-D
YD
Yoo
J-W
JW
Kim
W S
WS
Shim
T S
TS
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007723:Korea / Q000453:epidemiology; D017114:Liver Failure, Acute / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
D000995:Antitubercular Agents