Isolated hepatic tuberculosis in a transplanted liver

Abstract

The incidence of tuberculosis (TB) has been increasing, especially in immunocompromised patients. It was reported that the overall incidence of TB in solid-organ transplant recipients is 0.8%. Hepatic graft TB was reported once before in a child, who underwent living-related hepatic graft transplantation. A 43-year-old man underwent orthotropic liver transplantation (OLT) in October 1999. His pre-transplant work-up was negative for TB (history and PPD skin test). He developed an episode of acute rejection which responded to steroids. He was discharged home on December 1999 with normal liver function tests (LFT). His LFT remained normal during January 2000, but his serum transaminases were found elevated on February 2000 (aspartate aminotransferase [AST] 206, alanine aminotransferase [ALT] 266). A liver biopsy then showed no evidence of TB or cytomegalovirus disease. The patient continued to have stable elevation of his serum AST and ALT until late March 2000 when a repeat liver biopsy showed caseating granuloma. The patient was started on anti-TB medications, with which he was compliant. By mid-May 2000 he was doing well, with significant reduction in his transaminase levels (AST 72, ALT 79). A retrospective inquiry about the donor revealed that he was a healthy young man from India, who died in a road traffic accident. To our knowledge our patient appears to be the first case reported of isolated hepatic TB in the OLT patient population. It is likely that the allograft was infected prior to transplantation and the disease was reactivated nearly 3 months after the procedure.