| Autor: |
Higgins, Robert S. D., Kusne, Shimon, Reyes, Jorge, Yousem, Sam, Gordon, Robert, Van Thiel, David, Simmons, Richard L., Starzl, Thomas |
| Zdroj: |
Clinical Transplantation; April 1992, Vol. 6 Issue: 2 p81-90, 10p |
| Abstrakt: |
During a 9‐year period, from January 1981 to December 1989, 6 mycobacterial infections were diagnosed among 2380 orthotopic liver transplants performed at the University of Pittsburgh. These infectious complications, although rare, were a major source of morbidity and mortality (40%). There were several associated risk factors in these patients, including extensive travel through or birth in endemic areas, severe pretransplant illness, post‐transplant rejection requiring adjunct (i.e., OKT3) immunosuppression, and HIV infection. Five patients had M. tuberculosis(MTB) infections; the 6th patient developed a solitary pulmonary nodule which grew mycobacterium avium intracellulare (MAI). Invasive diagnostic studies were usually necessary to document MTB infection and tissue samples often revealed early granuloma formation. Multiple drug regimens (INH, Rifampin, Ethambutol, and Pyrazinamide) were initiated early in the clinical course and effective therapy was judged by resolution of the clinical illness and/or radiographic resolution. The patient with MAI had no pulmonary or infectious symptoms. He was observed without anti‐tuberculous therapy and the pulmonary nodule decreased in size 3 months after the diagnosis was made. We recommend that all patients have pre‐operative PPD skin tests. Only those patients who fall into high‐risk categories, demonstrating x‐ray evidence of pulmonary disease or those who have a documented recent skin conversion, should receive INH prophylaxis in the peri‐operative period because of the associated risk of INH hepatotoxicity in these patients. MAI infection in asymptomatic patients may be managed with expectant observation. If the patient develops pulmonary symptoms, or the lesion persists, pulmonary nodule resection and antituberculous chemotherapy guided by culture sensitivities may be appropriate. |
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