Tuberculosis in liver transplant recipients: experience of a South Indian liver transplant center.
Tuberculosis (TB) is a serious disease for liver transplant recipients (LTRs). Data on post-liver transplant TB from high-burden countries are scant. The aims of this study were to describe the prevalence of TB in LTRs from a high-prevalence area and to analyze the risk factors for the development of post-liver transplant TB. We performed a retrospective review of our database and a case-control study of identified cases with TB and age-matched LTRs without TB. The overall prevalence of TB in LTRs was comparable to the prevalence of TB in LTRs from low-prevalence countries (5/214 or 2.3%). A low rate of interferon-γ release assay (IGRA) testing before liver transplantation was observed (68/214 or 31%). Most patients were screened clinically and with chest radiography alone before transplantation. TB developed variably after transplantation [median = 72 days, interquartile range (IQR) = 534 days]. The presentation was mostly extrapulmonary and/or disseminated (4/5 or 80%). When cases with posttransplant TB were compared with matched healthy LTRs, the presence of unexplained granulomas in explants (2/5 or 40%, P = 0.01) was the only factor associated with the development of TB. When all explants showing granulomas were reviewed, TB (52.9%) remained the most common cause; however, in almost half (47.1%), other attributable causes were found. Patients were treated with a standard daily regimen for a median of 12 months (IQR = 7.5 months). Posttransplant TB was associated with a high mortality rate (2/5 or 40%). In conclusion, we observed a low prevalence of TB in LTRs from a high-prevalence region. The presence of granulomas suggestive of TB in liver explants warrants isoniazid prophylaxis in the absence of disease. Post-liver transplant TB is associated with a high mortality rate. The roles of routine IGRA testing and isoniazid prophylaxis in a high-prevalence setting urgently need to be studied.
Department of Liver Transplantation and Hepatobiliary Surgery, Global Hospitals and Health City, Chennai, India; Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Arikichenin
A
Olithselvan
Srinivas
S
Rajagopala
Mukul
M
Vij
Vivekanandan
V
Shanmugam
Naresh
N
Shanmugam
Mohammed
M
Rela
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D006099:Granuloma / Q000150:complications / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007194:India; D059425:Interferon-gamma Release Tests; D007538:Isoniazid / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D007538:Isoniazid