Liver Transplantation in a Monolung Patient: A Strategy of Sequential Treatments of Multiple Lung Tuberculosis Ca-vitations and Hepatocellular Carcinoma on Hepatitis B Related Virus Cirrhosis

Dino Donataccio, Paola Del Bravo, Alberto Masotto, Marcello Ceola, Francesco Calabrò, Matteo Donataccio

.

DOI: 10.4236/ss.2011.25057                

Abstract

The presence of extrahepatic infection is a contraindication for liver transplantation, even more if supported by an advanced pulmonary tuberculosis with persistent cavitation not curable with medical treatment. We report a case of a young patient with hepatocellular carcinoma on hepatitis B virus related liver cirrhosis and multiple lung tuberculosis cavitations. The patient was referred to our centre for liver transplantation. We adopted a strategy with sequential treatments. First a left extra-pericardial pneumonectomy was performed without opening the infected cavern, followed by a therapy with rifampicin, isoniazid and ethambutol for a period of nine months. After the cure of tuberculosis, the monolung patient eventually was listed for liver transplantation. An accurate planning of a multistep therapeutical strategy, an appropriate anesthetic management and a meticulous surgical technique allowed to successfully transplant a young patient suffering from three life-threatening diseases: cavitary tuberculosis, hepatitis B virus cirrhosis and hepatocellular carcinoma. Thirty months after liver transplantation the patient is in good health, with normal liver function, forced expiratory volume in one second of 42% (1.53 liters) and without any tuberculosis disease reactivation.

Keywords

Mycobacterium Tuberculosis, Infection, Pneumonectomy, Liver Disease, Liver Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	WHO Report 2009, “Global Tuberculosis Control: Epi- demiology, Strategy, Financing,” Geneva, World Health Organization, 2009.
[2]	A. Subramanian and S. Dorman, “Mycobacterium Tu-berculosis in Solid Organ Transplant Recipients,” Amer-ican Journal of Transplantation, Vol. 9, No. s4, 2009, pp. S57-S62. doi:10.1111/j.1600-6143.2009.02894.x
[3]	J. M. Aguado, J. Torre-Cisneros, J. Fortun, N. Benito, Y. Meije, A. Doblas, et al., “Tuberculosis in Solid-Organ Transplant Recipients: Consensus Statement of the Group for the Study of Infection in Transplant Recipients (GE- SITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology,” Clinical Infectious Diseases, Vol. 48, No. 9, 2009, pp. 1276-1284. doi:10.1086/597590
[4]	B. R. Yehia and E. A. Blumberg, “Mycobacterium Tu-berculosis Infection in Liver Transplantation,” Liver Transplantation, Vol. 16, No. 10, 2010, pp. 1129-1135. doi:10.1002/lt.22133
[5]	M. Donataccio, G. Dalle Ore and D. Donataccio, “The Ministransplant Procedure in Liver Transplantation,” Acta Gastroenterol Belg, Vol. 73, No. 3, 2010, pp. 367-369.
[6]	S. Nagai, Y. Fujimoto, K. Taira, H. Egawa, Y. Takada, T. Kiuchi, et al., “Liver Transplantation without Isoniazid Prophylaxis for Recipients with a History of Tuberculo-sis,” Clinical Transplantation, Vol. 21, No. 2, 2007, pp. 229-234. doi:10.1111/j.1399-0012.2006.00630.x
[7]	R. Barcena, E. Oton, M. A. Moreno, J. Fortùn, M. Gar- cia-Gonzalez, A. Moreno, et al., “Is Liver Transplantation Advisable for Isoniazid Fulminant Hepatitis in Active Extrapulmonary Tuberculosis?” American Journal of Transplantation, Vol. 5, No. 11, 2005, pp. 2796-2798. doi:10.1111/j.1600-6143.2005.01065.x
[8]	K. L. Nash, T. M. Yeung, P. J. Lehner, P. Gibbs and W. J. Griffiths, “Orthotopic Liver Transplantation for Subacute Hepatic Failure Following Partial Treatment of Isoni- az-id-Resistant Tuberculosis,” Transplant Infectious Disease, Vol. 10, No. 4, 2008, pp. 272-275. doi:10.1111/j.1399-3062.2007.00277.x