Urgent Living-Donor Liver Transplantation in a Patient With Concurrent Active Tuberculosis: A Case Report
| Autor: | B.-H. Jung, J.-I. Park, S.-G. Lee |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Cirrhosis medicine.medical_treatment Antitubercular Agents Levofloxacin 030230 surgery Liver transplantation Gastroenterology 03 medical and health sciences 0302 clinical medicine Hepatorenal syndrome Internal medicine Ascites medicine Isoniazid Living Donors Humans Tuberculosis Contraindication Transplantation business.industry Middle Aged medicine.disease Liver Transplantation Regimen Sputum 030211 gastroenterology & hepatology Surgery Liver function medicine.symptom Rifampin business Liver Failure |
| Zdroj: | Transplantation proceedings. 50(3) |
| ISSN: | 1873-2623 |
| Popis: | Background Although active tuberculosis (TB) is considered a contraindication for liver transplantation (LT), this is the only treatment in patients with liver failure and concurrent active TB. We report a case with successful urgent living-donor LT for irreversible liver failure in the presence of active TB. Case Presentation A 48-year-old man, with a history of decompensated alcoholic liver cirrhosis, was presented with stupor. At admission, his consciousness had deteriorated to semi-coma, and his renal function also rapidly deteriorated to hepatorenal syndrome. A preoperative computed tomography scan of the chest revealed several small cavitary lesions in both upper lobes, and acid-fast bacillus stain from his sputum was graded 2+. Adenosine deaminase levels from ascites were elevated, suggesting TB peritonitis. A first-line anti-TB drug regimen was started immediately (rifampin, isoniazid, levofloxacin, and amikacin). An urgent living-donor LT was performed 2 days later. After LT, the regimen was changed to second-line anti-TB drugs (amikacin, levofloxacin, cycloserine, and pyridoxine). The sputum acid-fast bacillus stain tested negative on postoperative day 10. His liver function remained well preserved, even after the reversion to first-line anti-TB treatment. The patient recovered without any anti-TB medication–related complications and was discharged. Conclusions LT can be prudently performed as a life-saving option, particularly for patients with liver failure and concurrent active TB. |
| Databáze: | OpenAIRE |
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