Tuberculosis in liver transplant patients

Area of Science:

• Medicine
• Infectious Diseases
• Transplantation

Background:

• Tuberculosis (TB) incidence is rising globally, particularly in urban settings and among immunosuppressed individuals.
• The specific risks and clinical features of TB in liver transplant (OLT) patients remain largely unknown.
• Immunosuppression post-OLT increases susceptibility to opportunistic infections like TB.

Purpose of the Study:

• To investigate the incidence and associated factors of tuberculosis in patients who have undergone liver transplantation (OLT).
• To describe the clinical presentation, diagnosis, and outcomes of TB in OLT recipients.
• To provide recommendations for managing TB in the context of liver transplantation.

Main Methods:

• Retrospective review of 550 liver transplant (OLT) patients over a 5-year period.
• Identification of patients diagnosed with tuberculosis (TB) post-OLT.
• Analysis of patient demographics, pre-transplant screening results, clinical manifestations, diagnostic methods, treatment regimens, and patient outcomes.

Main Results:

• Five out of 550 OLT patients (0.9%) developed tuberculosis.
• TB occurred between 2 to 57 months post-transplant, with presentations including pulmonary, peritoneal, and miliary disease.
• Fever, pulmonary lesions, and meningitis were common presenting symptoms; diagnostic challenges included positive acid-fast smears and cultures.
• All TB isolates were sensitive to standard anti-TB drugs.
• Three patients survived with treatment, while two expired due to TB complications.

Conclusions:

• Tuberculosis should be considered in OLT patients presenting with unexplained fever, given its high mortality rate.
• Liver transplantation can be safely performed in patients with active peritoneal tuberculosis under appropriate anti-TB therapy.
• Preventive TB therapy may be considered for high-risk OLT patients, though its role is debated.