Farrell F J, Keeffe E B, Man K M, Imperial J C, Esquivel C O
Department of Transplantation, California Pacific Medical Center, San Francisco 94115.
Dig Dis Sci. 1994 Oct;39(10):2255-9. doi: 10.1007/BF02090381.
Two patients with liver failure secondary to isoniazid hepatotoxicity were successfully treated with orthotopic liver transplantation. A 49-year-old man received isoniazid prophylaxis for a positive tuberculin test, and a 60-year-old woman was treated for active pulmonary tuberculosis with isoniazid, rifampin, and pyrazinamide. Both patients developed hepatic failure 4 and 1.5 months after initiation of antituberculous drug therapy, respectively. Liver transplantation was performed for progressive hepatic failure and was successful in both patients. The patient with active pulmonary tuberculosis was successfully treated with a modified antituberculous drug regimen while taking standard doses of immunosuppressive drugs after transplantation. In conclusion, liver transplantation is feasible and effective therapy for patients with isoniazid-induced hepatic failure, and active pulmonary tuberculosis may represent a relative rather than absolute contraindication to transplantation.
两名因异烟肼肝毒性继发肝衰竭的患者通过原位肝移植成功治愈。一名49岁男性因结核菌素试验阳性接受异烟肼预防性治疗，一名60岁女性因活动性肺结核接受异烟肼、利福平及吡嗪酰胺治疗。两名患者分别在抗结核药物治疗开始后4个月和1.5个月出现肝衰竭。因进行性肝衰竭接受肝移植，两名患者均获成功。患有活动性肺结核的患者在移植后服用标准剂量免疫抑制药物的同时，通过改良抗结核药物方案成功治愈。总之，肝移植对于异烟肼所致肝衰竭患者是可行且有效的治疗方法，活动性肺结核可能是移植的相对而非绝对禁忌证。
