Clinical Outcomes of Tuberculosis in Recipients After Living Donor Liver Transplantation

Abstract

BackgroundThis study aimed to determine clinical outcomes using various drugs during tuberculosis (TB) treatment among living donor liver transplant (LDLT) recipients with TB and to assess the impact of performing LDLT in patients with active TB at the time of LDLT.Material/MethodsOut of 1313 LDLT performed from June 1994 to May 2016, 26 (2%) adult patients diagnosed with active TB were included in this study. Active TB was diagnosed using either TB culture, PCR, and/or tissue biopsy.ResultsThe median age was 56 years and the male/female ratio was 1.6: 1. Most patients had pulmonary TB (69.2%), followed by extrapulmonary and disseminated TB (15.4% each). Fourteen (53.8%) patients underwent LDLT even with the presence of active TB. All patients concurrently received anti-TB [Rifampicin-based: 13 (50%); Rifabutin-based: 12 (46.2%); INH-based: 1 (3.8%)] and immunosuppressive drugs [Tacrolimus-based: 6 (23%); Sirolimus/Everolimus-based: 20 (77%)]. During treatment, adverse drug reactions (ADR) occurred in 34.6% of patients: acute rejection in 6 (23.1%), hepatotoxicity in 2 (7.7%), and blurred vision in 1 (3.8%). Twenty-three (88%) patients completed their TB treatment. Neither TB recurrence nor TB-specific mortality were observed. Three (11.5%) patients died of non-TB-related causes. The overall 5-year survival rate was 86.2%. Patients with ADRs had a higher incidence of incomplete TB treatment (log-rank: p=0.012). Furthermore, patients with incomplete treatment were significantly associated with decreased overall survival (log-rank: p<0.001). Immunosuppressive and anti-TB drugs used during TB treatment and performing LDLT in patients with active TB at the time of LDLT were not associated with ADRs and overall survival.ConclusionsOutcomes are generally favorable with intensive peri-operative evaluation and surveillance. ADRs and incomplete TB treatment may result in poor prognosis and increased mortality rates.

Rifabutin for treating tuberculosis in solid organ transplant recipients: A retrospective observational study and literature review

“…However, we did not observe significant differences in the proportion or type of toxicity between the different regimens. Data for rifabutin in the treatment of TB have shown variable liver toxicity rates that range from 8.3% to 40% 10,12 . In addition, the mortality rate during TB treatment was 22% in our cohort, and again, this was not significantly different between the groups.…”

“…It's remarkable the higher proportion of extrapulmonary and disseminated TB in our series as compared to that reported in the literature, where pulmonary TB alone predominates (69%‐73% 10,12,14 ). Although we do not know the reason for this discrepancy, it could be explained, at least in part, by the presence of heart transplant, which implies stronger immunosuppression.…”

“…An additional case was not included as received a short treatment with rifabutin and had multidrug‐resistant TB 11 . In total, we identified 59 patients who underwent SOT and were treated with different rifabutin‐containing regimens; of these, 56 were reported in 5 retrospective case series 7,10,12‐14 and 3 were reported as single case reports 15‐17 …”

“…The three largest case series reported 50 cases 10,12,13 . First, Tabarsi et al 10 reported 22 patients treated with rifabutin.…”

“…Liver toxicity occurred in 9 (40.1%) and thrombocytopenia in 5 (22.7%). Second, Salvador et al 12 included 26 patients who developed TB before or after receiving a living‐donor liver graft (13, 12, and 1 treated with rifampin‐, rifabutin‐, and non‐rifamycin‐based regimens, respectively). Of these, 23 patients (88%) completed the TB treatment (10 [83.3%] treated with rifabutin and 12 [92.3%] treated with rifampin‐based regimens), with 6 (23.1%) suffering acute cellular graft rejection (3 [25%] treated with rifabutin and 3 [23.1%] treated with rifampin).…”