Abstract:Objective:To study the diagnosis and treatment of tuberculosis infection after liver transplantation.
Methods:The clinical data of 2 cases of tuberculosis infection after liver transplantation in the author′s center and 56 cases in literature from 1988~2006 were reviewed retrospectively.
Results:Mycobacterium tuberculosis infection occurred in 2 of 110(1.8%) cases undergoing liver transplantation between 2001 and 2006 in the author′s center. Combined with data in the literature, the average morbidity is 0.77% (58/7 532). Pyrexia, poor appetite and weight loss were the most common presentations clinically. The diagnosis methods including chest Xray, PPD test, acid fast bacillus and invasive and histological test. There were two major antituberculous strategies: Group A was the usual tetragenous protocol inducing therapies (isoniazid; rifampicin; pyramide ethambutal) and maintaining therapy (isoniazid; rifampicin), Group B included fluoroquinolones (ofloxacin or moxifloxacin) combined with firstline antituberculous drugs. The two groups had similar average treatment time (10m vs 11.5m, P>0.05,ttest). The cure rate, hepatotoxicity incidence and TB correlated case fatality in Group B and A are 76.92% and 58.33%, 46.15% and 70.83%, and 15.83% and 41.67%, but with no statistic significance (P>0.05, Pearson Chisquare Test).
Conclusions:The diagnosis of posttransplant TB infection considerably relies on combined method. Invasive and histological procedure has more and more significance. The classical antituberculosis protocol shows high hepatotoxicity incidence and should be cautiously selected. Fluoroquinolones combined with firstline antituberculous drugs is a new protocol with satisfactory effect and low hepatotoxicity incidence, and therefore might be safer in the treatment of posttransplant tuberculosis.