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Living-donor liver transplantation in patients with concurrent active tuberculosis at transplantation

Authors
Lee Y.T.Hwang S.Lee S.-G.Kim K.-W.Choi N.-K.Park G.-C.Yu Y.-D.Yoo J.-W.Kim W.S.Shim T.S.
Issue Date
2010
Publisher
International Union against Tubercul. and Lung Dis.
Keywords
Liver transplantation; Living donors; Tuberculosis
Citation
International Journal of Tuberculosis and Lung Disease, v.14, no.8, pp 1039 - 1044
Pages
6
Indexed
SCI
SCIE
SCOPUS
Journal Title
International Journal of Tuberculosis and Lung Disease
Volume
14
Number
8
Start Page
1039
End Page
1044
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/15476
ISSN
1027-3719
1815-7920
Abstract
SETTING: Although active tuberculosis (TB) is a contra-indication for liver transplantation (LT), LT may be the only possible treatment option in patients with irreversible liver failure and concurrent TB. OBJECTIVES: To assess the outcome of LT in patients with concurrent TB and liver failure. METHODS: We retrospectively evaluated the clinical outcomes of nine LT recipients with concurrent TB in Korea, an intermediate TB burden country. RESULTS: The primary causes of living-donor LT (LDLT) in nine patients were anti-tuberculosis drugi nduced fulminant hepatic failure (n = 4) and end-stage liver disease (n = 5). The sites of active TB were the lungs (n = 5), lymph nodes (n = 3) and pleura (n = 1). After LDLT, most patients were treated with less hepatotoxic drugs, including fl uoroquinolones, ethambutol and cycloserine; none was treated with pyrazinamide. One patient experienced acute rejection, probably attributable to an interaction between rifampicin and cyclosporine. All nine patients, including one taking rifabutin, successfully completed anti-tuberculosis treatment and have been followed up for a median of 926 days after LDLT, without relapse of TB. CONCLUSION: When properly managed, the prognosis of LDLT recipients with concurrently active TB at transplantation is very favourable. The current protocol, which considers active TB an absolute contraindication for LT, should be modifi ed or relaxed, particularly for patients with LDLT. © 2010 The Union.
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Anam Hospital (Department of Hepato-Biliary-Pancreatic Surgery, Anam Hospital)
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