Clinical features and risk factors of tuberculosis in living‐donor liver transplant recipients

Abstract

The incidence of active tuberculosis (TB) among liver transplant recipients varies depending on the endemic area and various reported TB risk factors. Although living-donor liver transplantation (LDLT) is predominant in Japan, the TB incidence and risk factors among LDLT recipients are unknown. Active TB episodes among 1222 LDLT recipient cases from 1990 to 2007 were retrospectively reviewed. A matched case-control study was performed to identify risk factors for active TB infection. Nine patients (0.74%, 5 males and 4 females, median age 48 years) developed active TB following LDLT. The incidence of TB in adults (over 18 years) and in the later cohort (2000-2007) was more than that of children and in the early cohort (1990-1999), respectively. Seven of 9 patients were diagnosed within 1 year after LDLT. No patient received isoniazid for latent TB infection treatment before transplantation. TB infection was controlled with anti-tuberculous drugs in all affected patients. However, 2 patients died of graft failure. Univariate analyses identified severe Child-Pugh score (≥ 11) (P = 0.006; odds ratio [OR], 10.0; 95% confidence interval [CI], 1.9-51.5), requirement for plasma exchange or plasmapheresis (P = 0.009; OR, 10.0; 95% CI, 1.9-53.4), and ABO-incompatible transplantation (P = 0.0003; OR, 34.0; 95% CI, 4.7-248.3) as risk factors for onset of active TB infection. Patients having an elevated Child-Pugh score, plasma exchange or plasmapheresis, and ABO-incompatible transplantation should be considered at greater risk for active TB infection, and treatment for latent TB infection before transplantation should be considered.