Liver transplantation is associated with good clinical outcome in patients with active tuberculosis and acute liver failure due to anti‐tubercular treatment

Bartoletti, Michele; Martelli, Giulia; Tedeschi, Sara; Morelli, Cristina; Bertuzzo, Valentine; Tadolini, Marina; Pianta, Paolo; Cristini, Francesco; Giannella, Maddalena; Lewis, Russell E.; Pinna, Antonio; Viale, Pierluigi

doi:10.1111/tid.12658

Cited by 12 publications

(5 citation statements)

References 41 publications

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“…To the best of our knowledge, this study has the largest number of transplanted patients in a single center for ALF due to antitubercular drugs. Previously published studies include series of cases and isolated case reports 14 - 17 , and our series may contribute to the current literature regarding patient characteristics before transplantation and management of tuberculosis and outcome after transplantation.…”

Section: Discussionmentioning

confidence: 85%

“…A recent comprehensive review reported on 19 transplanted individuals without known liver disease with good long-term survival rates – however, 6 of these patients were from the Ichai cohort, and 10 were single case reports 17 . Based on these data, we can conclude that in general, single case reports describe cases with favorable outcomes, and authors are usually less motivated to publish cases with negative results, and therefore the reported survival rate in the review may have been overestimated.…”

Section: Discussionmentioning

confidence: 99%

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Liver transplantation for acute liver failure due to antitubercular drugs – a single-center experience

Martino¹,

Abdala²,

Villegas³

et al. 2018

Clinics

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OBJECTIVES:Patients receiving treatment for tuberculosis are at risk of developing acute liver failure due to the hepatotoxicity of antitubercular drugs. We aimed to describe our experience with liver transplantation from deceased donors in this situation.METHODS:We identified patients undergoing transplantation for acute liver failure due to antitubercular drugs in our prospectively maintained database.RESULTS:Of 81 patients undergoing transplantation for acute liver failure, 8 cases were attributed to antitubercular drugs during the period of 2006-2016. Regarding the time of tuberculosis treatment until the onset of jaundice, patients were on antitubercular drugs for a mean of 64.7 days (21-155 days). The model for end-stage liver disease (MELD) score of patients ranged from 32 to 47 (median 38), and seven patients underwent transplantation under vasopressors. The 1-year survival was 50%. Three patients died during the week following transplantation due to septic shock (including a patient with acute liver failure due to hepatic/disseminated tuberculosis), and the remaining patient died 2 months after transplantation due to pulmonary infection. There were 2 cases of mild rejection and 1 case of moderate rejection. Of the surviving patients, all were considered cured of tuberculosis after alternative drugs were given.CONCLUSION:Patients arrived very sick and displayed poor survival after deceased donor transplantation.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Liver transplantation for acute liver failure due to antitubercular drugs – a single-center experience

Martino¹,

Abdala²,

Villegas³

et al. 2018

Clinics

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“…There is ample literature showing the safety of ATT, as well as its efficacy in treating TB in LTRs undergoing LT for ATTinduced liver injury. 8 Although the risk of transmission of TB is likely to be prohibitively high in donors with abdominal or miliary TB, transmission from isolated pulmonary or cervical lymph node TB, remote from the liver may not be. INH prophylaxis may be unnecessary in the latter situation, if biopsy of the graft and hilar lymph nodes do not show granulomas.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Treatment with anti-TB medication may be prolonged and associated with adverse drug reactions. 7,8 The approach to the organ donor with TB in western countries is determined in the setting of low disease burden and high cadaveric organ donation rates. 1,5,[9][10][11] Europe, North America and Australia together host approximately 6% of the worlds burden of TB.…”

Section: Introductionmentioning

confidence: 99%

The potential liver donor with tuberculosis: A fresh look at international recommendations based on a survey of practice in Indian liver transplant centres

Govil

Satsangi

REDDY

et al. 2022

NMJI

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Background The western recommendations for the use of organs from liver donors with tuberculosis (TB) come from an environment where the burden of disease is low and cadaveric organ donation rates are high—in complete contrast to the Indian scenario, where these recommendations may be too restrictive. Methods A questionnaire relating to current practice on the use of organs from liver donors with TB was sent to all liver transplant centres in India. Results Responses were obtained from 94% of centres. Two-thirds accepted organs from deceased donors with TB in the elective setting, especially for recipients with a high MELD (Model for end-stage liver disease) score. The proportion rose by 1.5 times in the setting of acute liver failure. Two-thirds advised anti-TB treatment (ATT) for corresponding recipients, and the remaining advised isonicotinic acid hydrazide (INH) prophylaxis. Untreated living donors with TB were not accepted. Half the respondents accepted living donors after completion of ATT, and did not treat recipients postoperatively. The remainder accepted them after 8 weeks of treatment and advised INH prophylaxis or ATT for recipients. Conclusions That this practice has not impacted recipient outcomes suggests that the guidelines for management of liver donors and recipients may need to be altered for populations endemic for TB.

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“…4 Pregnant women with active TB represented an important challenge for both women and fetuses. 5 TB can be transmitted from mother to newborn neonate can be happened by very rare transmission called vertical transmission of TB by transplacental transmission through umbilical veins to the fetal liver and lungs or aspiration and swallowing of infected amniotic fluid in utero-or intrapartum causing primary infection of fetal lungs and gut. Transplacental infection occurs late in pregnant women and aspiration from amniotic fluid occurs in the perinatal period.…”

Section: Introductionmentioning

confidence: 99%

Management of tuberculosis during pregnancy: first line anti-tuberculosis drug

Bereda¹

2022

JLPRR

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Tuberculosis is a widespread, infectious disease caused by various strains of mycobacteria, commonly Mycobacterium tuberculosis. Tuberculosis not only responsible for an important proportion of the global burden of disease, but it is also an important contributor to maternal mortality, with the disease being among the three leading causes of death among women aged fifteen to forty five years. The main goals of tuberculosis treatment are to cure the patients, to prevent maternal and perinatal complications and to minimize the possibility of transmission of the bacillus to healthy individuals. First-line anti-tuberculosis treatment for medicine-sensitive tuberculosis can be highly effective; however, in absence of well-controlled studies in pregnant women, first-line tuberculosis medications have been listed as United States Food and Drug Administration pregnancy category C (ie, no adequate well-controlled human studies have been performed, but benefits may be acceptable despite potential risks) except ethambutol categorized as pregnancy category B. Rifampicin can be highly used by pregnant women; due to it is believed to be safe for pregnancy and no teratogenic effects has been observed. Neonates who born from mothers who have been taken rifampicin combination therapy may be developed an increased risk of haemorrhagic disorders in the new-born (postpartum hemorrhage); to avoid this postpartum hemorrhage supplemental vitamin K (10mg/day) should be given for the last four to eight weeks of pregnancy.

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Liver transplantation is associated with good clinical outcome in patients with active tuberculosis and acute liver failure due to anti‐tubercular treatment

Abstract: Our findings suggest that LT is an effective therapeutic option for patients with active TB developing ALF following ATT and should be considered for patients failing medical treatment.

Cited by 12 publications

References 41 publications

Liver transplantation for acute liver failure due to antitubercular drugs – a single-center experience

Liver transplantation for acute liver failure due to antitubercular drugs – a single-center experience

The potential liver donor with tuberculosis: A fresh look at international recommendations based on a survey of practice in Indian liver transplant centres

Management of tuberculosis during pregnancy: first line anti-tuberculosis drug

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