Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period

Póvoas, Diana; Machado, João; Perdigoto, Rui; Morbey, A.; Veloso, J. A. F.; Glória, Helena; Mateus, Élia; Martins, A. F.; Maltêz, Fernando; Barroso, Eduardo

doi:10.20344/amp.7052

Cited by 7 publications

(10 citation statements)

References 12 publications

(20 reference statements)

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“…Due to the absence of characteristic clinical features, an accurate TB diagnosis is very challenging and has the inherent risk of diagnostic delay, causing serious consequences in immunocompromised patients [3]. Therefore, a percutaneous tumor biopsy is a critical diagnostic tool for establishing a final diagnosis [4].…”

Section: Discussionmentioning

confidence: 99%

Multiple Tuberculomas in a Transplanted Liver Mimicking Metastases of Unknown Origin

Angeramo¹,

Antinucci²,

McCormack³

et al. 2020

JSCR

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Liver transplant recipients are immunocompromised patients, and are often susceptible to bacterial, fungal and virus infections. We report the case of liver-only tuberculomas occurring eleven years following a deceased donor liver transplantation, that was initially interpreted as metastases of unknown origin. Interestingly, only a few such cases have been reported, usually within the first two years after transplantation, often when more aggressive immunosuppression is required. Although it is accepted that tuberculosis incidence among solid organ transplant recipients is higher when compared with the general population, its late onset after transplantation is very unusual.

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Section: Discussionmentioning

confidence: 99%

Multiple Tuberculomas in a Transplanted Liver Mimicking Metastases of Unknown Origin

Angeramo¹,

Antinucci²,

McCormack³

et al. 2020

JSCR

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“…TB drug therapy was stopped or changed in 35% of the patients, mostly due to hepatoxicity (80%)[18]. Póvoas et al[19] described 8 cases of active TB after LT diagnosed in a transplant unit located in Lisbon, Portugal, over a five-year span. The incidence rates of PTB, EPTB and DTB were 37.5%, 37.5% and 25.0%, respectively.…”

Section: The Burden Of M Tuberculosis After Ltmentioning

confidence: 99%

“…Most cases were diagnosed more than 12 mo after transplantation. All patients received a four-drug treatment regimen, and one patient developed mild to moderate cholestasis that did not require therapy discontinuation[19].…”

Section: The Burden Of M Tuberculosis After Ltmentioning

confidence: 99%

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Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation

Silva

Juan

Fernández‐Ruiz

et al. 2019

WJG

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Solid organ transplantation (SOT) is the best treatment option for end-stage organ disease. Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection, particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis . Active tuberculosis (TB) after SOT is a significant cause of morbidity and mortality. Most cases of posttransplant TB are secondary to reactivation of latent tuberculosis infection (LTBI) due to the effects of long-term immunosuppressive therapy. Risk minimization strategies have been developed to diagnose LTBI and initiate treatment prior to transplantation. Isoniazid with vitamin B6 supplementation is the treatment of choice. However, liver transplantation (LT) candidates and recipients have an increased risk of isoniazid-induced liver toxicity, leading to lower treatment completion rates than in other SOT populations. Fluoroquinolones (FQs) exhibit good in vitro antimycobacterial activity and a lower risk of drug-induced liver injury than isoniazid. In the present review, we highlight the disease burden posed by posttransplant TB and summarize the emerging clinical evidence supporting the use of FQs for the treatment of LTBI in LT recipients and candidates.

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“…Tuberculosis (TB) incidence in solid organ transplant (SOT) recipients is reported between 0.25 to 13.7%, and occurs more often in countries and settings with high prevalence of TB [1], [2], [3], [4], [5]. Moreover, TB in SOT recipients carries high TB-related and SOT-related morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Management and diagnosis of tuberculosis in solid organ transplant candidates and recipients: Expert survey and updated review ,

Pennington

Kennedy

Chandra

et al. 2018

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Background: Optimal screening and management of latent tuberculosis infection (LTBI) and active tuberculosis (TB) in solid organ transplant (SOT) candidates and recipients is necessary to prevent morbidity and mortality.Methods: We conducted a cross-sectional survey of TB and transplant experts across the United States reviewing the clinical practice preferences on key management issues related to LTBI and TB in SOT candidates and recipients.Results: Thirty TB and 13 SOT experts were surveyed (response rate = 53.8%). Both groups agreed that tuberculin skin test (TST) and chest x-ray screening in SOT candidates was useful (78.6% and 84.6%, respectively). TST after SOT was not useful for most transplant experts and TB experts (0% vs. 32.1%, respectively), but both groups were split on usefulness of interferon gamma release assays (IGRA) in SOT recipients (42.9% TB experts vs. 46.2% SOT experts). Most experts recommend LTBI treatment prior to SOT if close monitoring is assured (82.1% TB experts vs. 76.9% transplant experts). LTBI treatment with isoniazid was preferred for patients on calcineurin inhibitors. Evaluation for suspected TB in SOT recipients varied, but most TB experts favored sputum testing (88.9%) whereas most transplant experts favored bronchoscopic testing (69.2%). Preferred TB treatment regimens in SOT recipients were similar to regimens recommended for immunocompetent patients.Conclusions: Most TB and transplant experts recommend evaluation and treatment for LTBI in SOT candidates. Liver transplant candidates, however, should only be treated if close monitoring can be assured and after consulting with a hepatologist. Practice preferences varied regarding the initial diagnostic approach for suspected TB in SOT recipients; however, most experts agreed that SOT recipients should receive similar treatments as immunocompetent patients.

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Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period

Cited by 7 publications

References 12 publications

Multiple Tuberculomas in a Transplanted Liver Mimicking Metastases of Unknown Origin

Multiple Tuberculomas in a Transplanted Liver Mimicking Metastases of Unknown Origin

Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation

Management and diagnosis of tuberculosis in solid organ transplant candidates and recipients: Expert survey and updated review ,

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