tailieunhanh - Tuberculosis in Liver Transplant Recipients: A Systematic Review and Meta-Analysis of Individual Patient Data

In the TB Control Programme in India, routine screening for HIV infection was not being carried out in tuberculosis patients till recently. Hence, many patients were being treated for tuberculosis under programme conditions without knowledge of the presence or absence of concurrent HIV infection. However, in high HIV prevalence States, there is a provision for routine referral of all TB patients for voluntary HIV- counselling and testing. The current RNTCP regimens in India are highly effective in the management of tuberculosis patients without HIV infection. There was insufficient information about their efficacy in HIV associated TB. Hence, the Indian Council of. | LIVER TRANSPLANTATION 15 894-906 2009 ORIGINAL ARTICLE Tuberculosis in Liver Transplant Recipients A Systematic Review and Meta-Analysis of Individual Patient Data Jon-Erik C. Holty 1 2 Michael K. Gould 1 2 4 Laura Meinke 5 Emmet B. Keeffe 3 and Stephen J. Ruoss2 1 Center for Primary Care and Outcomes Research Stanford University Stanford CA Divisions of 2Pulmonary and Critical Care Medicine and 3Gastroenterology and Hepatology Department of Medicine Stanford University School of Medicine Stanford CA 4 VA Palo Alto Health Care System Palo Alto CA and 5Division of Pulmonary and Critical Care Medicine Department of Medicine University of Arizona Tucson AZ Mycobacterium tuberculosis MTB causes substantial morbidity and mortality in liver transplant recipients. We examined the efficacy of isoniazid latent Mycobacterium tuberculosis infection LTBI treatment in liver transplant recipients and reviewed systematically all cases of active MTB infection in this population. We found 7 studies that evaluated LTBI treatment and 139 cases of active MTB infection in liver transplant recipients. Isoniazid LTBI treatment was associated with reduced MTB reactivation in transplant patients with latent MTB risk factors versus P and isoniazid-related hepatotoxicity occurred in 6 of treated patients with no reported deaths. The prevalence of active MTB infection in transplant recipients was . Nearly half of all recipients with active MTB infection had an identifiable pretransplant MTB risk factor. Among recipients who developed active MTB infection extrapulmonary involvement was common 67 including multiorgan disease 27 . The short-term mortality rate was 31 . Surviving patients were more likely to have received 3 or more drugs for MTB induction therapy P and to have been diagnosed within 1 month of symptom onset P and were less likely to have multiorgan disease P or to have experienced episodes of acute transplant rejection P . Compared with the .