Nash K L, Yeung T M, Lehner P J, Gibbs P, Griffiths W J H
Hepatobiliary and Transplant Unit, Cambridge University Teaching Hospitals NHS Trust, Addenbrookes's Hospital, Cambridge, UK.
Transpl Infect Dis. 2008 Jul;10(4):272-5. doi: 10.1111/j.1399-3062.2007.00277.x. Epub 2007 Sep 14.
The management of patients with pre-existing tuberculosis (TB) undergoing liver transplantation is challenging. Cautious immunosuppression is required to prevent reactivation of disease, and second-line anti-tuberculous treatment may be necessary to prevent graft hepatotoxicity. Furthermore, liver transplantation in the context of isoniazid-resistant TB has seldom been reported. We report on a 44-year-old man with recent isoniazid-resistant extra-pulmonary TB who developed subacute hepatic failure requiring emergency liver transplantation and treatment with second-line anti-tuberculous therapy. We demonstrate that patients who have pre-existing TB can be successfully treated with alternative anti-tuberculous medication while under immunosuppression post transplantation. Pre-existing TB, including resistant strains, should not be an absolute contraindication to liver transplantation.
对患有既往结核病（TB）的患者进行肝移植管理具有挑战性。需要谨慎进行免疫抑制以防止疾病复发，并且可能需要二线抗结核治疗以防止移植物肝毒性。此外，关于耐异烟肼结核病患者的肝移植报道很少。我们报告了一名44岁男性，近期患有耐异烟肼的肺外结核，发展为亚急性肝衰竭，需要紧急肝移植并接受二线抗结核治疗。我们证明，患有既往结核病的患者在移植后免疫抑制状态下可以用替代抗结核药物成功治疗。既往结核病，包括耐药菌株，不应成为肝移植的绝对禁忌症。
