Résumé
•Tuberculosis is a severe disease in liver transplant recipients, difficult to diagnose and difficult to treat.•As in other immunocompromised populations, most patients in this case series (20/23, 87%), had extra-pulmonary tuberculosis.•Median time from liver transplant to tuberculosis diagnosis was 10 months [5–40.5]; median time from first symptoms to diagnosis was 38 days [26–60]•Even though most patients had pre-transplant risk factors for tuberculosis, screening by IFN-gamma release assay was performed in only three patients.
Liver transplant recipients are at risk of tuberculosis, which is particularly difficult-to diagnose and to treat in this population.
Retrospective study of all cases of tuberculosis diagnosed from 2007 to 2022 in the French network of liver transplant sites.
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.
Extrapulmonary tuberculosis is a severe disease in liver transplant recipients. Systematic pre-transplant screening of latent tuberculosis may prevent most of them.