Diagnosis and treatment of latent tuberculosis infection in liver transplant recipients in an endemic area

Benito, Natividad; Sued, Omar; Moreno, Asunción; Horcajada, Juan Pablo; González, Julià; Navasa, Miquel; Rimola, Antoni

doi:10.1097/00007890-200211270-00006

Cited by 92 publications

(105 citation statements)

References 17 publications

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“…Although a vast majority of transplant candidates are anergic, tuberculin reactivity has been documented in 20-25% of these patients 15 and identifies a subgroup at risk for developing tuberculosis after transplantation. 16,17 The optimal management of tuberculin skin test-positive patients with end-stage liver disease continues to pose a dilemma for care providers. PPD has been traditionally used to screen tuberculosis.…”

Section: Diagnosis Of Tuberculosis In End-stage Liver Diseasementioning

confidence: 99%

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A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Dhiman

Saraswat

Rajekar

et al. 2012

Journal of Clinical and Experimental Hepatology

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Tuberculosis remains one of the 'Captains of the Men of Death' even today, particularly in the developing world. Its frequency is increased 14-fold in patients with chronic liver diseases (CLD) and liver cirrhosis, more so in those with decompensated disease, probably due to the cirrhosis-associated immune dysfunction syndrome, and case-fatality rates are high. The diagnosis of tuberculosis, particularly the interpretation of the Mantoux test, is also fraught with difficulties in CLD, especially after previous BCG vaccination. However, the greatest challenge in the patient with CLD or liver cirrhosis and tuberculosis is managing their therapy since the best first-line anti-tuberculosis drugs are hepatotoxic and baseline liver function is often deranged. Frequency of hepatotoxicity is increased in those with liver cirrhosis, chronic hepatitis B and chronic hepatitis C, possibly related to increased viral loads and may be decreased following antiviral therapy. If hepatotoxicity develops in those with liver cirrhosis, particularly decompensated cirrhosis, the risk of severe liver failure is markedly increased. Currently, there are no established guidelines for anti-tuberculosis therapy (ATT) in CLD and liver cirrhosis although the need for such guidelines is self-evident. It is proposed that ATT should include no more than 2 hepatotoxic drugs (RIF and INH) in patients with CLD or liver cirrhosis and stable liver function [ChildTurcotte-Pugh (CTP) #7], only a single hepatotoxic drug (RIF or INH) in those with advanced liver dysfunction and no hepatotoxic drugs with very advanced liver dysfunction (CTP $11). A standard protocol should be followed for monitoring ATT-related hepatotoxicity and for stop rules and reintroduction rules in all these patients, on the lines proposed here. It is hoped that these proposals will introduce uniformity and result in streamlining the management of these difficult patients. ( J CLIN EXP HEPATOL 2012;2:260-270)

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Section: Diagnosis Of Tuberculosis In End-stage Liver Diseasementioning

confidence: 99%

“…Interferon-gamma release assays have been tested and found to perform reasonably well in healthy populations as well as in patients with end-stage liver disease. [16][17][18][19] …”

Section: Diagnosis Of Tuberculosis In End-stage Liver Diseasementioning

confidence: 99%

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Dhiman

Saraswat

Rajekar

et al. 2012

Journal of Clinical and Experimental Hepatology

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“…However, the limitations of TST have been acknowledged: operational and biological (Benito et al, 2002;Muñoz et al, 2005). With all of operational steps, errors or problems can occur that will affect the accuracy of the test.…”

Section: Introductionmentioning

confidence: 99%

T-SPOT.TB for Detection of Tuberculosis Infection among Hematological Malignancy Patients and Hematopoietic Stem Cell Transplant Recipients

Qin¹,

Wang²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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The diagnosis of latent Mycobacterium tuberculosis infection (LTBI) is recommended in hematological malignancy patients and before hematopoietic stem cell transplantation (Guidelines for the prevention and management of infectious complications of solid organ transplantation, 2004). Compared to traditional methods such as tuberculin skin test (TST), T-SPOT.TB has been shown to be more specific. In the present study we enrolled 536 patients for whom T-SPOT.TB was performed, among which 295 patients also received the TST test. The agreement (79%) between T-SPOT.TB and TST was poor (κ=0.274, P<0.001). The patients with positive T-SPOT.TB results numbered 62 (11.6%), in which only 20 (48.8%) of the 41 receiving the TST test had positive results. A majority of the patients with T-SPOT.TB positive results had some other evidence ofTB, such as TB history, clinical symptoms and an abnormal chest CT scan. Active TB was found in 9 patients, in which 2 had negative TST results. We followed up the patients and no one developed active TB. Our study suggested that the T-SPOT.TB may be more useful for screening LTBI and active TB in hematological malignancy patients and hematopoietic stem cell transplant recipients than the TST test.

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“…A la fecha, isoniazida es el fármaco de elección para la profilaxis y ha demostrado ser efectiva en trasplante renal, hepático y cardíaco [19][20][21] . La ATS y el CDC recomiendan nueve meses de terapia.…”

Section: Tratamiento De La Tuberculosis Latenteunclassified

Profilaxis de tuberculosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos

Lafourcade

2012

Rev. chil. infectol.

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SuplementoProfilaxis de tuberculosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos Mónica LafourcadeProphylaxis against tuberculosis in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantationRecipients of SOT and HSCT constitute a risk group for becoming ill with tuberculosis (TB). The prevalence of active TB in patients undergoing TOS is higher than in patients undergoing HSCT, probably for the shortest period of immunosuppression of the latter. Most TB cases occur in transplant patients by reactivation of latent infection after immunosuppression, which occurs most often within the first year post-transplant, causing graft loss and in some cases death. Relevant variables to assess the risk of TB infection in a transplant recipient are the medical history of donor and recipient, images, microbiology and tuberculin tests and interferon gamma levels. PPD is routinely performed in the donor and in the recipient before transplantation. If PPD is > 5 mm in the recipient or > 10 mm in the donor, it is neccesary to exclude active TB (pulmonary and renal) (A2). It is recommended chemoprophylaxis in recipients PPD (+) and in recipients with recent seroconversion (B3), if the donor has a history of untreated TB, there was contact to someone with active TB (B3), the radiological imeges are suspect (A2) and interferon gamma release assays is (+) (B2). The selected drug is isoniazid (C3).

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Diagnosis and treatment of latent tuberculosis infection in liver transplant recipients in an endemic area

Cited by 92 publications

References 17 publications

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

T-SPOT.TB for Detection of Tuberculosis Infection among Hematological Malignancy Patients and Hematopoietic Stem Cell Transplant Recipients

Profilaxis de tuberculosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos

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