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Mycobacterium tuberculosis infection in pediatric liver transplant recipients
1Dulwich Public Health Laboratory and Medical Microbiology, King's College Hospital, London, UK. anil.dhawan@kcl.ac.uk
Insights
Tuberculosis (TB) affects 2.4% of pediatric liver transplant recipients, causing significant morbidity and mortality. Early screening and vigilant monitoring for isoniazid-induced hepatitis are crucial for effective management and improved outcomes in these vulnerable patients.
Area of Science:
- Pediatric Hepatology
- Transplant Infectious Diseases
- Mycobacterial Infections
Background:
- Liver transplantation in children is a complex procedure with potential for serious post-transplant complications.
- Tuberculosis (TB) remains a global health challenge, posing a particular risk to immunocompromised populations, including pediatric transplant recipients.
Observation:
- A retrospective review identified a 2.4% incidence of Mycobacterium tuberculosis infection in 254 pediatric liver transplant recipients between 1991 and 1998.
- Common clinical presentations included cough, pyrexia, and poor appetite, with half of patients having normal chest radiographs.
- Diagnostic methods involved Ziehl-Neelsen stain, M. tuberculosis PCR, Mantoux testing, and histopathology, with family screening aiding diagnosis in 4 cases.
Findings:
- The median time to diagnosis was 8 months, with treatment durations ranging from 9 to 18 months.
- Isoniazid-induced hepatitis occurred in two patients but resolved with dose adjustment.
- Mortality was observed in two patients due to Klebsiella septicemia and pulmonary hemorrhage.
Implications:
- Tuberculosis post-liver transplantation is associated with substantial morbidity and mortality.
- Pretransplant screening for personal and family history of TB, along with patient and family screening, is recommended.
- Standard anti-TB regimens are effective, but regular liver function monitoring is essential to manage drug-induced hepatotoxicity.
Objectives:
To study the incidence, clinical presentation, management, complications and outcome of tuberculosis in pediatric liver transplant recipients.
Methods:
A retrospective review of the medical records of children who underwent liver transplantation between 1991 and 1998.
Results:
Mycobacterium tuberculosis infection occurred in 6 of 254 (2.4%) children undergoing liver transplantation between 1991 and 1998. Cough, pyrexia and poor appetite were common presentations; one-half had normal chest radiographs. The median time to confirmation of diagnosis was 8 months (range, 1 to 17 months). Tests contributing to diagnosis included: Ziehl-Neelsen (ZN) stain (2 patients), M. tuberculosis polymerase chain reaction (1 patient), Mantoux test (1 patient) and histopathology (4 patients). Family health screening was productive for 4 patients. Duration of treatment varied from 9 to 18 months. Isoniazid-induced hepatitis was observed in 2 patients but resolved with dose reduction. Two patients died while receiving treatment, one of Klebsiella spp. septicemia and the other of pulmonary hemorrhage.
Conclusions:
Tuberculosis after liver transplantation has a significant morbidity and mortality. Pretransplantation a personal and family history of tuberculosis must be sought, and screening of patients and their families should be considered. Standard regimens incorporating isoniazid and rifampin are effective, but regular monitoring of liver function is essential to detect drug-induced hepatotoxicity.