Lauar ID, Faria LC, Romanelli RMC, Clemente WT. Latent tuberculosis: Risk factors, screening and treatment in liver transplantation recipients from an endemic area. World J Transplant 2021; 11(12): 512-522 [PMID: 35070787 DOI: 10.5500/wjt.v11.i12.512]
Corresponding Author of This Article
Isabela Dias Lauar, MD, Doctor, Professor, Medicine Department, Universidade José do Rosário Vellano, Rua Líbano, 66-Itapoã, Belo Horizonte 31710030, Minas Gerais, Brazil. belalauar@yahoo.com.br
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 18, 2021; 11(12): 512-522 Published online Dec 18, 2021. doi: 10.5500/wjt.v11.i12.512
Latent tuberculosis: Risk factors, screening and treatment in liver transplantation recipients from an endemic area
Isabela Dias Lauar, Luciana Costa Faria, Roberta Maia de Castro Romanelli, Wanessa Trindade Clemente
Isabela Dias Lauar, Medicine Department, Universidade José do Rosário Vellano, Belo Horizonte 31710030, Minas Gerais, Brazil
Luciana Costa Faria, Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30130100, Minas Gerais, Brazil
Roberta Maia de Castro Romanelli, Pediatrics Department, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30130100, Minas Gerais, Brazil
Wanessa Trindade Clemente, Department of Laboratory Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30130100, Minas Gerais, Brazil
Author contributions: Lauar ID, Faria LC, Romanelli RMC and Clemente WT contributed equally to this work in every aspect of study design, data collection and analysis, and manuscript preparation.
Institutional review board statement: The study was approved by the Federal University of Minas Gerais Research Ethics Committee (approval number: 0614.0.203.000-11).
Informed consent statement: All participants provided informed written consent about use of their data in the study and signed the Informed Consent Term.
Conflict-of-interest statement: The authors declare there is no potential conflict-of-interest in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Isabela Dias Lauar, MD, Doctor, Professor, Medicine Department, Universidade José do Rosário Vellano, Rua Líbano, 66-Itapoã, Belo Horizonte 31710030, Minas Gerais, Brazil. belalauar@yahoo.com.br
Received: July 26, 2021 Peer-review started: July 26, 2021 First decision: September 2, 2021 Revised: September 25, 2021 Accepted: November 14, 2021 Article in press: November 14, 2021 Published online: December 18, 2021
Abstract
BACKGROUND
Patients undergoing solid organ transplantation, particularly those who live or have lived in tuberculosis (TB) endemic areas, are at a high risk of developing TB. The majority of post-transplantation TB cases are associated with reactivation of latent TB infection (LTBI). Brazil is in a single position with overlapping areas of high TB endemicity and high transplant activity. In liver transplant (LT), one should be aware of the potential hepatotoxicity associated with the treatment regimens for LTBI.
AIM
To evaluate the frequency of LTBI in LT patients and treatment-related issues.
METHODS
This was a retrospective analysis of a cohort of cirrhotic patients aged ≥ 18 years, who underwent LT at a high-complexity teaching hospital from January 2005 to December 2012.
RESULTS
Overall, 429 patients underwent LT during the study period. Of these, 213 (49.7%) underwent the tuberculin skin test (TST) during the pre-transplant period, and 35 (16.4%) of them had a positive result. The treatment for LTBI was initiated after LT in 12 (34.3%) of the TST-positive patients; in 3 (25.0%), treatment was maintained for at least 6 mo.
CONCLUSION
The prevalence of LTBI was lower than expected. Initiation and completion of LTBI treatment was limited by difficulties in the management of these special patients.
Core Tip: In liver transplant, one should be aware of the potential hepatotoxicity associated with the treatment regimens for latent tuberculosis infection (LTBI). The aim of this study was to evaluate the frequency of LTBI in liver transplant patients and treatment-related issues. The prevalence of LTBI was lower than expected, probably due to low tuberculin skin test sensitivity in patients with impaired liver function. In addition, the initiation and completion of LTBI treatment was limited by difficulties in the management of patients in the presence of elevated liver enzymes and a potential risk of hepatotoxicity.
