Original Article

Evaluation of latent tuberculosis infection in liver transplant recipients

Abstract

Background and Objectives: Tuberculosis is one of the main reasons for mortality in liver transplant recipients. Since Iran is considered as a tuberculosis-endemic country, the present study aims to evaluate the outcome of latent tuberculosis infection in transplant recipients after liver transplantation.
Materials and Methods: The present analytical cross-sectional study was performed on transplanted patients in Imam Khomeini Complex Hospital in Tehran Iran from 2006 to 2016. All patients with positive tuberculin skin test were enrolled. Variables including demographic information, therapeutic and outcome data were gathered and analyzed.
Results: Among 675 transplant recipients, 100 patients had positive tuberculin skin test (14.8%). Sixty seven percent of recipients were men and the mean age was 72.67 ± 1.3 years. All patients' received Isoniazid prophylaxis before transplantation. The mean duration of anti- tuberculosis‎ prophylaxis before and after transplant were 2.7 ± 1.9 and 3.6 ± 5.5 months, respectively. Tuberculosis has not been occurred in none of these patients after a mean follow up time of 45.21 ± 3 months. During the study period, four subjects infected by Mycobacterium tuberculosis, while their skin test was negative before transplant.
Conclusion: According to our study, tuberculin skin test is a reliable and sensitive test for diagnosis of latent tuberculosis‎ in liver transplant candidates. Isoniazid prophylaxis is well tolerated in patients with end stage liver diseases and liver transplant recipients.

1. Holty JEC, Gould MK, Meinke L, Keeffe EB, Ruoss SJ. Tuberculosis in liver transplant recipients: A systematic review and meta‐analysis of individual patient data. Liver Transpl 2009; 15:894-906.
2. Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis 1998; 27:1266-1277.
3. Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in the United States: a disease‐specific analysis of the UNOS database. Liver Transpl 2004; 10:886-897.
4. Naqvi A, Rizvi A, Hussain Z, Hafeez S, Hashmi A, Akhtar F, et al. Developing world perspective of posttransplant tuberculosis: morbidity, mortality, and cost implications. Transplant Proc 2001; 33: 1787-1788.
5. Muñoz P, Rodríguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis 2005; 40:581-587.
6. Maher D (2009). The natural history of Mycobacterium tuberculosis infection in adults. In: Tuberculosis. Eds, Alimuddin I Zumla, H Simon Schaaf. Elsevier, pp. 129-132.
7. WHO. Estimates of TB and MDR-TB burden are produced by WHO in consultation with countries. Generated: 2019-09-21. www.who.int/tb/data
8. Hand J, Sigel K, Huprikar S, Hamula C, Rana M. Tuberculosis after liver transplantation in a large center in New York City: Quanti FERON®‐TB Gold‐based pre‐transplant screening performance and active tuberculosis post‐transplant. Transpl Infect Dis 2018; 20(2):e12845.
9. Ahmadinejad Z, Azmoudeh Ardalan F, Razzaqi M, Davoudi S, Jafarian A. QuantiFERON-TB Gold In-Tube test for diagnosis of latent tuberculosis (TB) infection in solid organ transplant candidates: a single-center study in an area endemic for TB. Transpl Infect Dis 2013; 15:90-95.
10. Manuel O, Humar A, Preiksaitis J, Doucette K, Shokoples S, Peleg AY, et al. Comparison of Quantiferon-TB Gold with tuberculin skin test for detecting latent tuberculosis infection prior to liver transplantation. Am J Transplant 2007; 7: 2797-2801.
11. Pavoni M, Biagetti C, Dal Monte P, Ballardini G, Morelli C, Sambri V, et al. Usefulness of the Quantiferon-TB Gold In-Tube test for detecting latent tuberculosis infection in patients with cirrhosis candidate for orthotopic liver transplantation. Digest Liver Dis 2007; 39: A39-A40.
12. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American thoracic society/infectious diseases society of America/centers for disease control and prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis 2017; 64:111-115.
13. Knoll BM, Nog R, Wu Y, Dhand A. Three months of weekly rifapentine plus isoniazid for latent tuberculosis treatment in solid organ transplant candidates. Infection 2017; 45:335-339.
14. Fishman JA, Greenwald MA, Grossi PA. Transmission of infection with human allografts: essential considerations in donor screening. Clin Infect Dis 2012; 55: 720-727.
15. Kucirka LM, Alexander C, Namuyinga R, Hanrahan C, Montgomery RA, Segev DL. Viral nucleic acid testing (NAT) and OPO-level disposition of high-risk donor organs. Am J Transplant 2009; 9: 620-628.
16. Dummer JS, Thomas LD (2015). Risk Factors and Approaches to Infections in Transplant Recipients. In: Principles and Practice of Infectious Diseases. Ed, Mandell, Douglas, and Bennett’s. Elsevier. pp. 3420.
Files
IssueVol 13 No 2 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v13i2.5981
Keywords
Liver transplantation; Latent tuberculosis; Active tuberculosis
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Ahmadinejad Z, Mokhtaryan M, Salami A, Talebian M, Irajian H, Ghiasvand F. Evaluation of latent tuberculosis infection in liver transplant recipients. Iran J Microbiol. 2021;13(2):199-203.