Salvador Noruel Gerard A, Wee Sin-Yong, Lin Chih-Che, Wu Chao-Chien, Lu Hung-I, Lin Ting-Lung, Lee Wei-Feng, Chan Yi-Chia, Lin Li-Man, Chen Chao-Long
Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Transplantation Center and Department of Surgery,, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ann Transplant. 2018 Oct 19;23:733-743. doi: 10.12659/AOT.911034.
BACKGROUND This study aimed to determine clinical outcomes using various drugs during tuberculosis (TB) treatment among living donor liver transplant (LDLT) recipients with TB and to assess the impact of performing LDLT in patients with active TB at the time of LDLT. MATERIAL AND METHODS Out of 1313 LDLT performed from June 1994 to May 2016, 26 (2%) adult patients diagnosed with active TB were included in this study. Active TB was diagnosed using either TB culture, PCR, and/or tissue biopsy. RESULTS The median age was 56 years and the male/female ratio was 1.6: 1. Most patients had pulmonary TB (69.2%), followed by extrapulmonary and disseminated TB (15.4% each). Fourteen (53.8%) patients underwent LDLT even with the presence of active TB. All patients concurrently received anti-TB [Rifampicin-based: 13 (50%); Rifabutin-based: 12 (46.2%); INH-based: 1 (3.8%)] and immunosuppressive drugs [Tacrolimus-based: 6 (23%); Sirolimus/Everolimus-based: 20 (77%)]. During treatment, adverse drug reactions (ADR) occurred in 34.6% of patients: acute rejection in 6 (23.1%), hepatotoxicity in 2 (7.7%), and blurred vision in 1 (3.8%). Twenty-three (88%) patients completed their TB treatment. Neither TB recurrence nor TB-specific mortality were observed. Three (11.5%) patients died of non-TB-related causes. The overall 5-year survival rate was 86.2%. Patients with ADRs had a higher incidence of incomplete TB treatment (log-rank: p=0.012). Furthermore, patients with incomplete treatment were significantly associated with decreased overall survival (log-rank: p<0.001). Immunosuppressive and anti-TB drugs used during TB treatment and performing LDLT in patients with active TB at the time of LDLT were not associated with ADRs and overall survival. CONCLUSIONS Outcomes are generally favorable with intensive peri-operative evaluation and surveillance. ADRs and incomplete TB treatment may result in poor prognosis and increased mortality rates.
背景 本研究旨在确定活体肝移植（LDLT）受者合并结核病（TB）时在结核病治疗期间使用各种药物的临床结局，并评估在LDLT时对活动性结核病患者进行LDLT的影响。
材料与方法 在1994年6月至2016年5月进行的1313例LDLT中，本研究纳入了26例（2%）被诊断为活动性结核病的成年患者。活动性结核病通过结核培养、聚合酶链反应（PCR）和/或组织活检进行诊断。
结果 中位年龄为56岁，男女比例为1.6:1。大多数患者患有肺结核（69.2%），其次是肺外结核和播散性结核（各占15.4%）。14例（53.8%）患者即使在存在活动性结核病的情况下也接受了LDLT。所有患者同时接受抗结核药物[以利福平为基础：13例（50%）；以利福布汀为基础：12例（46.2%）；以异烟肼为基础：1例（3.8%）]和免疫抑制药物[以他克莫司为基础：6例（23%）；以西罗莫司/依维莫司为基础：20例（77%）]。在治疗期间，34.6%的患者发生了药物不良反应（ADR）：急性排斥反应6例（23.1%），肝毒性2例（7.7%），视力模糊1例（3.8%）。23例（88%）患者完成了结核病治疗。未观察到结核病复发或结核病特异性死亡。3例（11.5%）患者死于非结核病相关原因。总体5年生存率为86.2%。发生ADR的患者结核病治疗未完成的发生率更高（对数秩检验：p=0.012）。此外，治疗未完成的患者与总体生存率降低显著相关（对数秩检验：p<0.001）。结核病治疗期间使用的免疫抑制药物和抗结核药物以及在LDLT时对活动性结核病患者进行LDLT与ADR和总体生存率无关。
结论 通过强化围手术期评估和监测，结局总体良好。ADR和结核病治疗未完成可能导致预后不良和死亡率增加。
