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

Authors

  • Diana Póvoas Serviço de Doenças Infecciosas. Hospital de Curry Cabral. Lisboa. Portugal.
  • João Machado Serviço de Doenças Infecciosas. Hospital de Curry Cabral. Lisboa. Portugal. Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.
  • Rui Perdigoto Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.
  • Ana Morbey Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.
  • Júlio Veloso Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.
  • Helena Glória Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.
  • Élia Mateus Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.
  • Américo Martins Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.
  • Fernando Maltez Serviço de Doenças Infecciosas. Hospital de Curry Cabral. Lisboa. Portugal.
  • Eduardo Barroso Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

DOI:

https://doi.org/10.20344/amp.7052

Keywords:

Liver Transplantation, Mycobacterium tuberculosis, Portugal, Tuberculosis

Abstract

Introduction: Tuberculosis incidence in Portugal ranged from 20 to 22 cases per 100 000 inhabitants between 2010 and 2014. Tuberculosis incidence in liver transplant recipients is not precisely known, but it is estimated to be higher than among the general population. Tuberculosis in liver transplant recipients is particularly challenging because of the atypical clinical presentation and side effects of the antibacillary drugs and their potential interactions with immunosuppressive therapies.
Material and Methods: We retrospectively reviewed the clinical records of liver transplant recipients with post-transplant tuberculosis occurring from January 2010 to December 2014 at a liver transplantation unit in Lisbon, Portugal. Demographic data, baseline and clinical features, as well as treatment regimen, toxicities and outcomes, were analyzed.
Results: Among 1005 recipients, active tuberculosis was diagnosed in eight patients between January 2010 and December 2014 (frequency = 0.8%). Late onset tuberculosis was more frequent than early tuberculosis. Mycobacterium tuberculosis complex was isolated from cultures in almost every case (7; 87.5%). Extra-pulmonary involvement and disseminated tuberculosis were frequent. Two patients developed rejection without allograft loss. Crude mortality was 37.5%, with 2 deaths being related to tuberculosis.
Discussion: Despite the uncertainty regarding treatment duration in liver transplant recipients, disease severity, as well as number of active drugs against TB infection, should be taken into account. There was a need for a rifampin-free regimen and immunosuppression adjustment in patients who experienced acute graf rejection.
Conclusion: Although the number of cases of tuberculosis is low, its post-transplant frequency is significant and the observed mortality rate is not to be neglected. The cases of hepatotoxicity and graft rejection seen in this case series demonstrate the challenges associated with tuberculosis diagnosis in liver transplant recipients and management of the interactions between immunosuppressors and rifampin. This study strengthens the recommendation of latent tuberculosis infection screening and treatment in liver transplant candidates or recipients.

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Author Biographies

Diana Póvoas, Serviço de Doenças Infecciosas. Hospital de Curry Cabral. Lisboa. Portugal.

Serviço de Doenças Infecciosas

João Machado, Serviço de Doenças Infecciosas. Hospital de Curry Cabral. Lisboa. Portugal. Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Serviço de Doenças Infecciosas, Centro Hepato-Bilio-Pancreático e Transplantação

Rui Perdigoto, Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Centro Hepato-Bilio-Pancreático e Transplantação

Ana Morbey, Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Centro Hepato-Bilio-Pancreático e Transplantação

Júlio Veloso, Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Centro Hepato-Bilio-Pancreático e Transplantação

Helena Glória, Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Centro Hepato-Bilio-Pancreático e Transplantação

Élia Mateus, Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Centro Hepato-Bilio-Pancreático e Transplantação

Américo Martins, Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Centro Hepato-Bilio-Pancreático e Transplantação

Fernando Maltez, Serviço de Doenças Infecciosas. Hospital de Curry Cabral. Lisboa. Portugal.

Serviço de Doenças Infecciosas

Eduardo Barroso, Centro Hepato-Bilio-Pancreático e Transplantação. Hospital de Curry Cabral. Lisboa. Portugal.

Centro Hepato-Bilio-Pancreático e Transplantação

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Published

2017-01-31

How to Cite

1.
Póvoas D, Machado J, Perdigoto R, Morbey A, Veloso J, Glória H, Mateus Élia, Martins A, Maltez F, Barroso E. Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period. Acta Med Port [Internet]. 2017 Jan. 31 [cited 2024 Mar. 29];30(1):41-6. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/7052

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Original