title: Liver transplantation is associated with good clinical outcome in patients with active tuberculosis and acute liver failure due to anti-tubercular treatment.
abstract: BACKGROUND
  Active tuberculosis (TB) is commonly considered a contraindication for liver transplantation (LT). However, in patients with TB who develop acute liver failure (ALF) due to toxicity induced by anti-tubercular treatment (ATT), LT could be the only opportunity for treatment. The aim of this study was to evaluate the feasibility of LT in this scenario.
  
  
  METHODS
  We described 2 cases and comprehensively reviewed the literature finding 26 cases of LT performed in patients having a concomitant active TB and liver failure secondary to ATT toxicity.
  
  
  RESULTS
  TB was classified as pulmonary in 18/26 (69%), nodal in 3/26 (11%) TB cases, while the remaining 5/26 cases included disseminated, pleural, renal, ovarian, and vertebral TB localization (1 case each). ATT following LT consisted mainly of isoniazid or rifampin (RIF)-sparing regimens and included primarily fluoroquinolones and ethambutol. Rejection episodes and liver toxicity were reported in 19% and 8% of patients respectively. Graft rejection was more frequent among patients treated with RIF-containing regimens (P<.001). Mortality rate was 15% after a median follow up of 12 months. In only one case was death attributed to uncontrolled TB infection.
  
  
  CONCLUSIONS
  Our findings suggest that LT is an effective therapeutic option for patients with active TB developing ALF following ATT and should be considered for patients failing medical treatment.
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bartoletti
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Martelli
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tedeschi
authors.affiliation: Internal Medicine Unit for the Treatment of Severe Organ Failure, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Morelli
authors.affiliation: Liver and Multi-Organ Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Valentine
authors.initials: V
authors.lastname: Bertuzzo
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Tadolini
authors.affiliation: Internal Medicine Unit for the Treatment of Severe Organ Failure, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pianta
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cristini
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.affiliation: Liver and Multi-Organ Transplant Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004977:Ethambutol / Q000009:adverse effects / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification / Q000502:physiology; D011379:Prognosis; D012293:Rifampin / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin
keywords: anti-tubercular treatment; liver failure; liver transplantation; tuberculosis