Characteristics, management, and outcome of tuberculosis after liver transplant: A case series and literature review

Background: Liver transplant recipients are at risk of tuberculosis, which is particularly difficult-to diagnose and to treat in this population. Methods: Retrospective study of all cases of tuberculosis diagnosed from 2007 to 2022 in the French network of liver transplant sites. Results: Twenty-three liver transplant recipients were diagnosed with tuberculosis (six females, median age 59 years [interquartile range, 54-62]), with a median time lapse of 10 months [5-40.5] after transplant, and 38 days [26-60] after symptoms onset. Primary modes of pathogenesis were latent tuberculosis reactivation (n = 15) and transplant-related transmission (n = 3). Even though most patients with pre-transplant data had risk factors for tuberculosis (11/20), IFN-gamma release assay was performed in only three. Most cases involved extra-pulmonary tuberculosis (20/23, 87 %). With median follow-up of 63 months [24-108], five patients died (22 %), including four tuberculosis-related deaths. Conclusions: Extrapulmonary tuberculosis is a severe disease in liver transplant recipients. Systematic pretransplant screening of latent tuberculosis may prevent most of them.