Gastroenterology and Hepatology Unit, Faculty of Medicine, Marqués de Valdecilla University Hospital, Santander, Spain.
Liver Transpl. 2012 Sep;18(9):1110-7. doi: 10.1002/lt.23480.
A patient receiving a liver graft needs to be treated with immunosuppressive drugs to avoid rejection. These kinds of drugs predispose the patient to the reactivation of latent infections such as tuberculosis (TB). Therefore, it is necessary to establish treatment regimens to prevent this. We retrospectively analyzed all consecutive patients undergoing liver transplantation (LT) at our center between January 1, 2000 and December 31, 2010. Latent tuberculosis infections (LTBIs) were diagnosed with positive tuberculin skin test results. After LT, infected patients were treated with isoniazid for 6 months; the treatment began soon after transplantation, and the patients were followed until the end of the study. During this period, 53 patients had LTBI data. All these patients were treated with isoniazid after LT. The median observation period after LT was 52 months (range = 12-129 months). No cases of TB reactivation were reported during follow-up. Only 4 patients presented alterations in liver enzymes related to this treatment, and they showed clear improvement after the treatment was stopped. None of these patients showed severe graft dysfunction. In conclusion, preventive isoniazid appears to be a safe drug for use in LTBI patients after LT. The treatment may be established just after LT without important graft dysfunction or severe consequences for the patient.
接受肝移植的患者需要接受免疫抑制药物治疗以避免排斥反应。这些药物使患者容易重新激活潜伏性感染，如结核病（TB）。因此，有必要制定治疗方案来预防这种情况。我们回顾性分析了 2000 年 1 月 1 日至 2010 年 12 月 31 日期间在我们中心接受肝移植（LT）的所有连续患者。潜伏性结核感染（LTBI）通过结核菌素皮肤试验阳性结果诊断。LT 后，感染患者用异烟肼治疗 6 个月；治疗在移植后立即开始，患者随访至研究结束。在此期间，53 例患者有 LTBI 数据。所有这些患者在 LT 后均接受异烟肼治疗。LT 后中位观察期为 52 个月（范围=12-129 个月）。随访期间未报告结核再激活病例。仅 4 例患者出现与该治疗相关的肝酶改变，停药后明显改善。这些患者均未出现严重移植物功能障碍。总之，预防性异烟肼似乎是 LTBI 患者 LT 后安全的药物。治疗可以在 LT 后立即进行，而不会对移植物功能产生重要影响，也不会对患者造成严重后果。
