Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052 |
Resumo: | Introduction: Tuberculosis incidence in Portugal ranged from 20 to 22 cases per 100 000 inhabitants between 2010 and 2014. Tuberculosis incidence in liver transplant recipients is not precisely known, but it is estimated to be higher than among the general population. Tuberculosis in liver transplant recipients is particularly challenging because of the atypical clinical presentation and side effects of the antibacillary drugs and their potential interactions with immunosuppressive therapies.Material and Methods: We retrospectively reviewed the clinical records of liver transplant recipients with post-transplant tuberculosis occurring from January 2010 to December 2014 at a liver transplantation unit in Lisbon, Portugal. Demographic data, baseline and clinical features, as well as treatment regimen, toxicities and outcomes, were analyzed.Results: Among 1005 recipients, active tuberculosis was diagnosed in eight patients between January 2010 and December 2014 (frequency = 0.8%). Late onset tuberculosis was more frequent than early tuberculosis. Mycobacterium tuberculosis complex was isolated from cultures in almost every case (7; 87.5%). Extra-pulmonary involvement and disseminated tuberculosis were frequent. Two patients developed rejection without allograft loss. Crude mortality was 37.5%, with 2 deaths being related to tuberculosis.Discussion: Despite the uncertainty regarding treatment duration in liver transplant recipients, disease severity, as well as number of active drugs against TB infection, should be taken into account. There was a need for a rifampin-free regimen and immunosuppression adjustment in patients who experienced acute graf rejection.Conclusion: Although the number of cases of tuberculosis is low, its post-transplant frequency is significant and the observed mortality rate is not to be neglected. The cases of hepatotoxicity and graft rejection seen in this case series demonstrate the challenges associated with tuberculosis diagnosis in liver transplant recipients and management of the interactions between immunosuppressors and rifampin. This study strengthens the recommendation of latent tuberculosis infection screening and treatment in liver transplant candidates or recipients. |
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Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year PeriodTuberculose em Transplantados Hepáticos: Uma Série de Oito Casos Durante um Período de Cinco AnosLiver TransplantationMycobacterium tuberculosisPortugalTuberculosisMycobacterium tuberculosisPortugalTuberculoseTransplante de FígadoIntroduction: Tuberculosis incidence in Portugal ranged from 20 to 22 cases per 100 000 inhabitants between 2010 and 2014. Tuberculosis incidence in liver transplant recipients is not precisely known, but it is estimated to be higher than among the general population. Tuberculosis in liver transplant recipients is particularly challenging because of the atypical clinical presentation and side effects of the antibacillary drugs and their potential interactions with immunosuppressive therapies.Material and Methods: We retrospectively reviewed the clinical records of liver transplant recipients with post-transplant tuberculosis occurring from January 2010 to December 2014 at a liver transplantation unit in Lisbon, Portugal. Demographic data, baseline and clinical features, as well as treatment regimen, toxicities and outcomes, were analyzed.Results: Among 1005 recipients, active tuberculosis was diagnosed in eight patients between January 2010 and December 2014 (frequency = 0.8%). Late onset tuberculosis was more frequent than early tuberculosis. Mycobacterium tuberculosis complex was isolated from cultures in almost every case (7; 87.5%). Extra-pulmonary involvement and disseminated tuberculosis were frequent. Two patients developed rejection without allograft loss. Crude mortality was 37.5%, with 2 deaths being related to tuberculosis.Discussion: Despite the uncertainty regarding treatment duration in liver transplant recipients, disease severity, as well as number of active drugs against TB infection, should be taken into account. There was a need for a rifampin-free regimen and immunosuppression adjustment in patients who experienced acute graf rejection.Conclusion: Although the number of cases of tuberculosis is low, its post-transplant frequency is significant and the observed mortality rate is not to be neglected. The cases of hepatotoxicity and graft rejection seen in this case series demonstrate the challenges associated with tuberculosis diagnosis in liver transplant recipients and management of the interactions between immunosuppressors and rifampin. This study strengthens the recommendation of latent tuberculosis infection screening and treatment in liver transplant candidates or recipients.Introdução: A incidência de tuberculose em Portugal entre 2010 - 2014 foi de 20 a 22 casos por 100 000 habitantes. A incidência de tuberculose em transplantados hepáticos não é conhecida, estimando-se que seja mais elevada do que a da população em geral. O manejo da tuberculose em transplantados hepáticos constitui um desafio, não só pela apresentação clínica frequentemente atípica, mas também pelos efeitos secundários da terapêutica antibacilar e suas interações farmacológicas com a medicação imunossupressora, necessária no período pós-transplante.Material e Métodos: Os autores fizeram uma revisão retrospetiva dos casos de doentes transplantados hepáticos com tuberculose pós- transplante diagnosticada durante o período entre janeiro 2010 e dezembro 2014 num centro de transplantação hepática em Lisboa, Portugal. Foram analisados os dados demográficos, características clínicas, a par do regime antibacilar, toxicidade e evolução.Resultados: Num total de 1005 transplantados foi diagnosticada tuberculose ativa em oito doentes entre janeiro de 2010 e dezembro de 2014 (frequência de 0,8%). O desenvolvimento de tuberculose tardia foi mais frequente do que a doença precoce. Foi isolado Mycobacterium tuberculosis complex no exame cultural de sete doentes (87,5%). Foram frequentes a presença de envolvimento extrapulmonar, assim como doença tuberculosa disseminada. Dois doentes desenvolveram rejeição aguda, sem perda de enxerto. A taxa de mortalidade global foi de 37,5%, com duas mortes directamente atribuíveis à tuberculose.Discussão: Apesar da incerteza quanto à duração do tratamento da tuberculose em transplantados hepáticos, deverão ser tidos em conta a gravidade da doença, assim como o número de fármacos com actividade antibacilar. Nesta série, os doentes que desenvolveram rejeição aguda necessitaram da utilização de um regime sem rifampicina, e ajuste da terapêutica imunossupressora.Conclusão: Apesar do baixo número de casos de tuberculose, a sua frequência pós-transplante é significativa e a mortalidade associada não é negligenciável. Os casos de hepatotoxicidade e rejeição de enxerto demonstram os desafios no diagnóstico da tuberculose em transplantados hepáticos e a dificuldade do manejo das interações entre imunossupressores e a rifampicina. Este estudo reforça a recomendação de rastreio e tratamento de tuberculose latente em transplantados ou candidatos a transplante hepático.Ordem dos Médicos2017-01-31info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfimage/jpegimage/jpegimage/jpegimage/jpegimage/jpeghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052oai:ojs.www.actamedicaportuguesa.com:article/7052Acta Médica Portuguesa; Vol. 30 No. 1 (2017): January; 41-46Acta Médica Portuguesa; Vol. 30 N.º 1 (2017): Janeiro; 41-461646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/4890https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7937https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7938https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7939https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7940https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7941Direitos de Autor (c) 2017 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessPóvoas, DianaMachado, JoãoPerdigoto, RuiMorbey, AnaVeloso, JúlioGlória, HelenaMateus, ÉliaMartins, AméricoMaltez, FernandoBarroso, Eduardo2022-12-20T11:05:04Zoai:ojs.www.actamedicaportuguesa.com:article/7052Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:24.319351Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period Tuberculose em Transplantados Hepáticos: Uma Série de Oito Casos Durante um Período de Cinco Anos |
title |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period |
spellingShingle |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period Póvoas, Diana Liver Transplantation Mycobacterium tuberculosis Portugal Tuberculosis Mycobacterium tuberculosis Portugal Tuberculose Transplante de Fígado |
title_short |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period |
title_full |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period |
title_fullStr |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period |
title_full_unstemmed |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period |
title_sort |
Tuberculosis in Liver Transplant Recipients: A Report of Eight Cases During a Five Year Period |
author |
Póvoas, Diana |
author_facet |
Póvoas, Diana Machado, João Perdigoto, Rui Morbey, Ana Veloso, Júlio Glória, Helena Mateus, Élia Martins, Américo Maltez, Fernando Barroso, Eduardo |
author_role |
author |
author2 |
Machado, João Perdigoto, Rui Morbey, Ana Veloso, Júlio Glória, Helena Mateus, Élia Martins, Américo Maltez, Fernando Barroso, Eduardo |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Póvoas, Diana Machado, João Perdigoto, Rui Morbey, Ana Veloso, Júlio Glória, Helena Mateus, Élia Martins, Américo Maltez, Fernando Barroso, Eduardo |
dc.subject.por.fl_str_mv |
Liver Transplantation Mycobacterium tuberculosis Portugal Tuberculosis Mycobacterium tuberculosis Portugal Tuberculose Transplante de Fígado |
topic |
Liver Transplantation Mycobacterium tuberculosis Portugal Tuberculosis Mycobacterium tuberculosis Portugal Tuberculose Transplante de Fígado |
description |
Introduction: Tuberculosis incidence in Portugal ranged from 20 to 22 cases per 100 000 inhabitants between 2010 and 2014. Tuberculosis incidence in liver transplant recipients is not precisely known, but it is estimated to be higher than among the general population. Tuberculosis in liver transplant recipients is particularly challenging because of the atypical clinical presentation and side effects of the antibacillary drugs and their potential interactions with immunosuppressive therapies.Material and Methods: We retrospectively reviewed the clinical records of liver transplant recipients with post-transplant tuberculosis occurring from January 2010 to December 2014 at a liver transplantation unit in Lisbon, Portugal. Demographic data, baseline and clinical features, as well as treatment regimen, toxicities and outcomes, were analyzed.Results: Among 1005 recipients, active tuberculosis was diagnosed in eight patients between January 2010 and December 2014 (frequency = 0.8%). Late onset tuberculosis was more frequent than early tuberculosis. Mycobacterium tuberculosis complex was isolated from cultures in almost every case (7; 87.5%). Extra-pulmonary involvement and disseminated tuberculosis were frequent. Two patients developed rejection without allograft loss. Crude mortality was 37.5%, with 2 deaths being related to tuberculosis.Discussion: Despite the uncertainty regarding treatment duration in liver transplant recipients, disease severity, as well as number of active drugs against TB infection, should be taken into account. There was a need for a rifampin-free regimen and immunosuppression adjustment in patients who experienced acute graf rejection.Conclusion: Although the number of cases of tuberculosis is low, its post-transplant frequency is significant and the observed mortality rate is not to be neglected. The cases of hepatotoxicity and graft rejection seen in this case series demonstrate the challenges associated with tuberculosis diagnosis in liver transplant recipients and management of the interactions between immunosuppressors and rifampin. This study strengthens the recommendation of latent tuberculosis infection screening and treatment in liver transplant candidates or recipients. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-01-31 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052 oai:ojs.www.actamedicaportuguesa.com:article/7052 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052 |
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oai:ojs.www.actamedicaportuguesa.com:article/7052 |
dc.language.iso.fl_str_mv |
eng |
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eng |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/4890 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7937 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7938 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7939 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7940 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7052/7941 |
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Direitos de Autor (c) 2017 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2017 Acta Médica Portuguesa |
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openAccess |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 30 No. 1 (2017): January; 41-46 Acta Médica Portuguesa; Vol. 30 N.º 1 (2017): Janeiro; 41-46 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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