Mycobacterium tuberculosis infection in pediatric liver transplant recipients

Objectives. To study the incidence, clinical presentation, management, comp lications and outcome of tuberculosis in pediatric liver transplant recipie nts. Methods, A retrospective review of the medical records of children who unde rwent liver transplantation between 1991 and 1998. Results. Mycobacterium tuberculosis infection occurred in 6 of 254 (2.4%) c hildren undergoing liver transplantation between 1991 and 1998. Cough, pyre xia and poor appetite were common presentations; one-half had normal chest radiographs. The median time to confirmation of diagnosis was 8 months (ran ge, 1 to 17 months). Tests contributing to diagnosis included: Ziehl-Neelse n (ZN) stain (2 patients), M. tuberculosis polymerase chain reaction (1 pat ient), Mantoux test (1 patient) and histopathology (4 patients). Family hea lth screening was productive for 4 patients. Duration of treatment varied f rom 9 to 18 months. Isoniazid-induced hepatitis was observed in 2 patients but resolved with dose reduction. Two patients died while receiving treatme nt, one of Klebsiella spp, septicemia and the other of pulmonary hemorrhage . Conclusions. Tuberculosis after liver transplantation has a significant mor bidity and mortality, Pretransplantation a personal and family history of t uberculosis must be sought, and screening of patients and their families sh ould be considered. Standard regimens incorporating isoniazid and rifampin are effective, but regular monitoring of liver function is essential to det ect drug-induced hepatotoxicity.