Tuberculosis in liver transplant recipients: Experience of a South Indian liver transplant center

Abstract

Tuberculosis (TB) is a serious disease for liver transplant recipients (LTRs). Data on post-liver transplant TB from high-burden countries are scant. The aims of this study were to describe the prevalence of TB in LTRs from a high-prevalence area and to analyze the risk factors for the development of post-liver transplant TB. We performed a retrospective review of our database and a case-control study of identified cases with TB and age-matched LTRs without TB. The overall prevalence of TB in LTRs was comparable to the prevalence of TB in LTRs from low-prevalence countries (5/214 or 2.3%). A low rate of interferon-g release assay (IGRA) testing before liver transplantation was observed (68/214 or 31%). Most patients were screened clinically and with chest radiography alone before transplantation. TB developed variably after transplantation [median 5 72 days, interquartile range (IQR) 5 534 days]. The presentation was mostly extrapulmonary and/or disseminated (4/5 or 80%). When cases with posttransplant TB were compared with matched healthy LTRs, the presence of unexplained granulomas in explants (2/5 or 40%, P 5 0.01) was the only factor associated with the development of TB. When all explants showing granulomas were reviewed, TB (52.9%) remained the most common cause; however, in almost half (47.1%), other attributable causes were found. Patients were treated with a standard daily regimen for a median of 12 months (IQR 5 7.5 months). Posttransplant TB was associated with a high mortality rate (2/5 or 40%). In conclusion, we observed a low prevalence of TB in LTRs from a highprevalence region. The presence of granulomas suggestive of TB in liver explants warrants isoniazid prophylaxis in the absence of disease. Post-liver transplant TB is associated with a high mortality rate. The roles of routine IGRA testing and isoniazid prophylaxis in a high-prevalence setting urgently need to be studied. Tuberculosis (TB) continues to be a global scourge. India has the highest TB burden and accounts for approximately one-fifth (21%) of the global disease burden. It is estimated that approximately 40% of the Indian population is infected with the TB bacillus, and the prevalence of smear-positive pulmonary cases remains approximately 75/100,000.

Mycobacterium tuberculosisafter solid organ transplantation: A review of more than 2000 cases

“…The median age was 45 (range 31‐64) and 49 (range, 19‐74) years among cohorts and case reports, respectively. Twenty‐one studies calculated mean age of 39.44 years (range, 24.2‐54.4). Most patients were male (1301/2073 [62.76%]).…”

“…A total of 253 TB cases among liver recipients were reported in 20 cohort studies and 22 case reports . Of these, 78 of 106 cases (73.58%) were male.…”

“…The median age was 45 (range 31-64) and 49 (range, years among cohorts and case reports, respectively. Twenty-one studies 139,140,148,[152][153][154][155][156][157][158]165,168,170,171,173,175,177,178,183,186,188 The overall incidence of TB was 1.69% (range, 0.027-13.27).…”

“…A total of 253 TB cases among liver recipients were reported in 20 cohort studies 141,142,144,146,147,149,151,153,157,161,163,169,171,172,175,177,184,185,187,189 and 22 case reports. 8,10,15,18,22,27,31,32,39,45,47-49, 72,76,77,93,104,114,115,124,137 Of these, 78 of 106 cases (73.58%) were male.…”

Explant liver evaluation decodes the mystery of cryptogenic cirrhosis!

“…It has been noted that alfa feto protein is usually not elevated when cumulative tumor size is smaller. 25 An earlier study from our center had shown that there was a low prevalence of TB in postliver transplant recipients. However, recurrence is rare in those with incidentally detected HCC.…”