Implications for management of Mycobacterium tuberculosis infection in adult-to-adult live donor liver transplantation

Abstract

Background: Mycobacterium tuberculosis (TB) infection is a serious opportunistic infection especially in live donor liver transplantation (LDLT). Hepatotoxicity of antituberculous agents and hazardous drug interaction with immunosuppressants may render the graft more susceptible to injury. Aim of study: To review our experience of management of TB infection in liver transplant recipients including LDLT. Patients and methods: A total of 397 liver transplantations were performed in the University of Hong Kong Medical Centre from January 1991 to December 2004. Eight patients (2.0%) developed TB infection after transplantation (LDLT: n = 6, DDLT: n = 2) and their clinical courses were reviewed. Result: The mean time of developing TB infection after liver transplantation was 9 months (range 4-20 months). Anti-TB treatment was administered for a mean duration of 12.7 months (11-18 months). None of our patients developed antituberculous drug-induced hepatotoxicity or had unwanted drug interaction. With a mean follow-up of 65 months (range 18-102 months), one patient died due to the recurrence of hepatocellular carcinoma. Conclusion: High index of suspicion for TB infection should be warranted for a history of cough and fever after liver transplantation. No notable difference was observed in the natural history and management of TB infection between LDLT and DDLT. The use of antituberculous drugs is safe in liver transplant recipients provided that liver function is closely monitored and the dosage of immunosuppressants is adjusted accordingly. © 2006 Blackwell Munksgaard.