Funda COŞKUN, Merve SAKARYA, Kerem SELİMOĞLU, Halit Ziya DÜNDAR, Murat KIYICI, Remzi İŞÇİMEN, Dilek YESİLBURSA, Ekrem KAYA

Karaciğer Nakil Hastalarında Latent Tüberküloz Tedavi Yaklaşımı: Bursa Uludağ Üniversitesi Deneyimi

Bu çalışmada Bursa Uludağ Üniversitesi Tıp Fakültesi’nde değerlendirilen ve karaciğer nakli yapılan hastalardaki latent tüberküloz sıklığını ve tedavi durumlarını incelemeyi amaçladık. Son 2 yıl içerisinde karaciğer nakli amacıyla başvuran 16’sı kadın 60 hasta çalışmaya alındı. Yaş ortalaması 53,8 idi. Olguların değerlendirmesinde 39 olguda tüberkülin cilt testi (TCT) 5 mm ve üzerinde pozitif olarak değerlendirildi. Olguların 25’inde karaciğer nakli gerçekleşmişti. Bütün olgular Göğüs Hastalıkları Anabilim Dalı tarafından değerlendirilerek TCT pozitif olan olgulara izoniyazid profilaksisi önerildi. Tedavi önerilen olguların sadece 3 tanesinin ilacını kullandığı saptandı. Latent tüberküloz tedavisi başlanılması önerilen olguların sadece %8’inin tedavi aldığını saptadık. Latent tüberküloz tedavisi karaciğer nakli olan hastalarda TCT pozitifliği saptanması durumunda rehberler tarafından kuvvetle önerilmektedir. Olgularımızda bu çalışmayı yaparak uyum oranının çok düşük olduğunu saptadık. Düzenli takiplere gelen bu hastaların profilaksi tedavisini kullanmaları yönünde değerlendirilmesi gerekmektedir.

Anahtar Kelimeler:

Tüberküloz, Karaciğer nakli, TCT, Profilaksi

Treatment of Latent Tuberculosis in Liver Transplantation Patients: Bursa Uludag University Experience

We aimed to investigate the incidence and treatment status of latent tuberculosis in patients who underwent liver transplantation at Bursa Uludag University School of Medicine. Sixty patients (16 female) who were admitted for liver transplantation in the last 2 years were included in the study. The mean age was 53.8 years. Tuberculin skin test (TST) in 39 cases was found to be positive or greater than 5 mm. Liver transplantation was performed in 25 patients. All cases were evaluated by the Department of Chest Diseases and isoniazid prophylaxis was recommended to the patients who were positive for TST. It was determined that only 3 of the patients were treated with medication. We found that only 8% of the patients recommended to receive latent tuberculosis treatment. Latent tuberculosis treatment is strongly recommended by the guidelines in the presence of TST positivity in patients with liver transplantation. In this study, we found that the compliance rate was very low. Prophylaxis treatment should be considered in these patients who attend regular follow-up.

Keywords:

Tuberculosis, liver transplantation, TST, profilaxia,

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1. Jafri SM, Singal A, Kaul D, et al. Detection and management of latent tuberculosis in liver transplant patients. Liver Transplantation 2011; 17: 306-14.
2. Stucchi RSB, Boin IFSF, Angerami RN, et al. Is isoniazid safe for liver transplant candidates with latent tuberculosis. Transplantation Proceedings 2012; 44:2406-10.
3. Subramanian AK, Morris MI. AST Infectious Diseases Community of Practice. Mycobacterium tuberculosis infections in solid organ transplantation. Am J Transplant 2013; 13 (Suppl 4): 68-76.
4. Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis 1998; 27 (5): 1266-77.
5. Klote MM, Agodoa LY, Abbott K. Mycobacterium tuberculosis infection incidence in hospitalized renal transplant patients in the United States, 1998–2000. Am J Transplant 2004; 4 (9): 1523-28.
6. Torre-Cisneros J, Doblas A, Aguado JM, et al. Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort. Clin Infect Dis 2009; 48 (12): 1657-65.
7. Eyüpoğlu Ö. Solid Organ Nakli ve Tüberküloz. In Tüberküloz Tanı ve Tedavi Rehberi. 2. Baskı Ankara, 2019: 92-4.
8. Munoz P, Rodriguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis 2005; 40 (4): 581-7.
9. Lopez de Castilla D, Schluger NW. Tuberculosis following solid organ transplantation. Transpl Infect Dis 2010; 12 (2): 106-12.
10. Cavusoglu C, Cicek-Saydam C, Karasu Z, et al. Mycobacterium tuberculosis infection and laboratory diagnosis in solid organ transplant recipients. Clin Transplant. 2002 Aug;16(4):257-61.
11. Özgen Alpaydın A, Ozbilgin M, Abdullayeva M, et al. Determinants and characteristics of tuberculosis in liver transplant recipients. Turk J Med Sci 2018; 48: 1803-144
12. Eyüboğlu FÖ, Küpeli E, Bozbaş SS, et al. Evaluation of pulmonary infections in solid organ transplant patients: 12 years experience. Transplant Proc. 2013;45(10):3458-61.