title: Tuberculosis in liver transplant recipients: prophylaxis in an endemic area.
abstract: BACKGROUND
  Tuberculosis (TB) has a high prevalence in Brazil. The scenario of liver transplantation (LT) creates challenges: atypical presentation, treatment hepatotoxicity, and increased mortality. The majority of TB cases after transplantation represent reactivation of latent infections; therefore, prophylaxis (PX) plays a major role. The aim of this study was to evaluate the benefits of PX after LT based on a pretransplantation tuberculin test (TT) in an endemic area.
  
  
  METHODS
  Retrospective analysis of medical data from 376 adult cirrhotic patients undergoing OLT from 2001 to 2009.
  
  
  RESULTS
  Among 191 selected patients, 137 (71%) showed a pretransplant TT including 41 (30%) with a TT ≥5 mm. The 17 (40%) of these patients who were prescribed PX did not experience TB. Prophylaxis was discontinued in 5 patients (20%) owing to suspicion of hepatotoxicity (medium serum alanine transaminase 175 U/L). In the group without PX, we diagnosed 1 case of pulmonary TB. The overall prevalence of anergic patients in the cirrhotic phase was 65% and prevalence of TB 1%.
  
  
  CONCLUSIONS
  The prevalence of TB was similar to that reported in the literature, but positivity to TT was higher (34% vs 25%), possibly because of the endemicity of the area. There was a lower prevalence of extrapulmonary disease and no mortality. No patient undergoing PX with isoniazid, although incomplete due to suspicion of hepatotoxicity displayed TB. One patient without PX was affected by TB. The drug was effective but not always safe.
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplant, Hospital Geral de Bonsucesso, Rio de Janeiro, Brasil. luagoglia@ig.com.br
authors.forename: L
authors.initials: L
authors.lastname: Agoglia
authors.forename: E
authors.initials: E
authors.lastname: Balbi
authors.forename: M
authors.initials: M
authors.lastname: Halpern
authors.forename: J
authors.initials: J
authors.lastname: Roma
authors.forename: L
authors.initials: L
authors.lastname: Carius
authors.forename: J M
authors.initials: JM
authors.lastname: Martinho
authors.forename: L P
authors.initials: LP
authors.lastname: Moreira
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents