Clinical Presentation and Outcome of Tuberculosis in Kidney, Liver, and Heart Transplant Recipients in Spain1

Aguado, José María; Herrero, J A; Gavaldá, Joan; Torre‐Cisneros, Julián; Blanes, Marino; Rufí, Gabriel; Moreno, Asunción; Gurguí, Mercé; Hayek, M; Lumbreras, Carlos; Cantarell, C.

doi:10.1097/00007890-199705150-00015

Cited by 303 publications

(301 citation statements)

References 34 publications

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“…28 In our series, these cases represented only 2.8% of 566 patients admitted with severe hepatitis between 1986 and 2008. 29 According to a retrospective study of patients from the United Network for Organ Sharing registry (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), 0.07% of LT procedures for ALF were due to ATT (50 of 73,977 transplant patients).…”

Section: Discussionmentioning

confidence: 58%

Acute liver failure due to antitubercular therapy: Strategy for antitubercular treatment before and after liver transplantation

et al. 2010

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The standard antitubercular treatment (ATT), which consists of isoniazid (INH), rifampicin (RIF), ethambutol, and pyrazinamide (PZA), is the best available treatment for tuberculosis (TB). However, the hepatotoxicity of INH and PZA can be severe, and even after drug withdrawal, patients may require liver transplantation (LT). In these cases, the strategy for the treatment of TB is poorly defined. Between 1986 and 2008, 14 patients presented at our department with severe hepatitis secondary to INH and PZA treatment. Four of these patients were immunosuppressed: 2 after renal transplantation and 2 because of human immunodeficiency virus infection. In seven of the 14 patients an alternative ATT was begun on admission, which was well tolerated. Hepatitis improved spontaneously in 5 patients, and alternative ATT was continued for 9.3 6 4.2 months; 1 patient deteriorated and underwent LT, and 1 patient died. ATT was stopped definitively in 2 patients. Six patients required urgent LT, and alternative ATT was started after transplantation and was successful. Five patients receiving RIF had an episode of acute rejection. In conclusion, hepatitis secondary to ATT can be successfully treated with alternative anti-TB regimens. The use of RIF in LT patients may lead to acute rejection. RIF should therefore be avoided in these patients.

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Section: Discussionmentioning

confidence: 58%

Acute liver failure due to antitubercular therapy: Strategy for antitubercular treatment before and after liver transplantation

et al. 2010

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“…The prevalence of mycobacterial infection in the 9 12/1202 (1.0) Heart 9 6/585 (1.0) Kidney (Saudi Arabia) 10 14/403 (3.5) BMT (current report) 4/641 (0. 6) immunosuppressed BMT patient is lower than one would expect in this immunocompromised patient population, and this holds true in endemic and non-endemic areas.…”

Section: Discussionmentioning

confidence: 99%

“…Prevalence of TB is also lower than TB rates in other organ transplant populations (Table 3). 9 Renal transplant recipients in Saudi Arabia had a tuberculosis rate of 3.5%. 10 AIDS patients are another group of immunosuppressed patients in whom TB is more common.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients

Aljurf

Gyger

Alrajhi

et al. 1999

Bone Marrow Transplant

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Summary:Bone marrow transplant (BMT) recipients are prone to bacterial, viral and fungal infections. Mycobacterium tuberculosis infection can occur in these patients, but the incidence is lower than that of other infections. This report describes four patients with Mycobacterium tuberculosis infection identified from 641 adult patients who received a BMT over a 12-year period (prevalence 0.6%). The pre-transplant diagnosis was AML in two patients and CML in the other two. Pre-transplant conditioning consisted of BU/CY in three patients and CY/TBI in one. Graft-versus-host disease (GVHD) prophylaxis was MTX/CsA in three patients and T cell depletion of the graft in one patient. Sites of infection were lung (two), spine (one) and central nervous system (one). Onset of infection ranged from 120 days to 20 months post BMT. Two patients had co-existing CMV infection. One patient had graft failure. The two patients who received anti-tuberculous (TB) therapy recovered from the infection. Although the incidence of tuberculosis in BMT patients is not as high as in patients with solid organ transplants, late diagnosis due to the slow growth of the bacterium can lead to delay in instituting anti-TB therapy. A high index of suspicion should be maintained, particularly in endemic areas.

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“…5,6 In a large Spanish series, 12 of 24 liver transplant recipients with TB (50%) developed hepatotoxicity during treatment. 25 Another major challenge in treating TB in transplant patients is the use of rifampin, which can significantly decrease serum levels of calcineurin inhibitors and mammalian target of rapamycin inhibitors and alter corticosteroid metabolism. 3,5,6,17 For this reason, rifamycins must be used with extreme caution in transplant recipients.…”

Section: Treatment Latent Tbmentioning

confidence: 99%

Mycobacterium tuberculosis infection in liver transplantation

Yehia

Blumberg

2010

Liver Transpl

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Mycobacterium tuberculosis can cause significant infections in liver transplant candidates and recipients. Its nonspecific clinical features and prolonged growth time in culture make the diagnosis difficult, and treating tuberculosis (TB) remains challenging because of significant toxicities and drug-drug interactions. The diagnosis of a latent TB infection may be accomplished with tuberculin skin testing and with the newer interferon-c release assays, although this infection may be underrecognized because of host factors. Latent TB should be treated, but the degree of liver failure and the likelihood of progression to active TB will dictate whether this should occur before or after transplantation. Patients who have a history of TB, have used muromonab-CD3 or anti-T lymphocyte antibodies, or have experienced allograft rejection or coinfection with cytomegalovirus, Pneumocystis jiroveci, or Nocardia are at the greatest risk of developing active TB. Active TB in transplant patients is difficult to treat because of drug-induced hepatotoxicity and the significant interaction between rifampin and calcineurin inhibitors. In this article, we review the epidemiology, clinical features, and evaluation of transplant candidates and recipients. In addition, we offer recommendations on the appropriate diagnostic and treatment regimens for patients with latent and active TB infections. Liver Transpl 16:1129-1135, 2010. V C 2010 AASLD.Received April 5, 2010; accepted July 6, 2010.Tuberculosis (TB) is a serious global infection with an estimated prevalence of 13.7 million cases worldwide. 1 Transplant recipients have a 36-to 74-fold higher risk of developing TB versus the general population. 2 TB in liver transplant recipients presents unique challenges, including a delayed diagnosis secondary to insensitive testing and treatment complications due to antituberculous drug toxicities and interactions with immunosuppressive agents. This review focuses on the epidemiology, clinical features, diagnosis, clinical evaluation, and treatment of liver transplant patients infected with TB. EPIDEMIOLOGYRates of 0.47% to 2.3% for active TB in adult liver transplant recipients has been reported. [2][3][4][5] Because of the difficulty of accurately diagnosing symptomatic TB, these figures most likely underestimate the burden of the disease. In addition, the frequency of the disease varies geographically, with particular regions (Asia and Africa) having a higher prevalence than other areas of the world. 6 Several factors place transplant patients at greater risk of developing active TB.A previous TB infection increases the likelihood of TB developing after transplantation. 5 The RESITRA (Spanish Network of Infection in Transplantation) cohort documented a relative risk of 4.3 for the development of symptomatic TB when the purified protein derivative (PPD) test was positive instead of negative. 4 In a systematic review of 139 cases of active TB infection after liver transplantation, 37% had a positive tuberculin skin test (TST), 23% had abnorm...

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Clinical Presentation and Outcome of Tuberculosis in Kidney, Liver, and Heart Transplant Recipients in Spain1

Abstract: M tuberculosis causes serious and potentially life-threatening disease in solid-organ transplant recipients. Treatment with at least three drugs during 9 months or more, avoiding the use of rifampin, appears to be appropriate.

Cited by 303 publications

References 34 publications

Acute liver failure due to antitubercular therapy: Strategy for antitubercular treatment before and after liver transplantation

Acute liver failure due to antitubercular therapy: Strategy for antitubercular treatment before and after liver transplantation

Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients

Mycobacterium tuberculosis infection in liver transplantation

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