To investigate the clinical features, diagnosis, treatment and therapeutic efficacy of Mycobacterium tuberculosis (TB) infection in liver transplant recipients.

Among 336 liver transplant recipients who were followed up in the Third Affiliated Hospital of Sun Yat-sen University from October 2003 to December 2011, 3 recipients were diagnosed as TB infection after liver transplantation (LT). Two of them were male and one was female, aged 36-59 years old with the mean age of 47 years old. The three recipients underwent improved piggy-back orthotopic liver transplantation. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. They received Tacrolimus-based immunosuppressive therapy. The clinical features, diagnosis, treatment and therapeutic efficacy were collected and analyzed and the relevant literatures were reviewed.

The incidence of TB infection after LT in our center was 0.9% (3/336). Three patients developed TB 43 d, 19 months and 27 months after LT (15.8 month mean time) with atypical clinical manifestations. Two of them suffered from fever, one developed cough and sputum, one had night sweats and weight loss and the third patient had no obvious symptoms except positive purified protein derivative (PPD) test. Mycobacterium tuberculosis was isolated from wound in one patient. All the 3 patients were diagnosed as infiltrative pulmonary tuberculosis, among them one with combined abdominal TB. The time elapsed between onset of symptoms and diagnosis was 7, 7 and 395 d respectively (mean: 136 d) . After receiving anti-TB treatment, 1 case was cured, 1 was relieved and 1 was not cured.

Tuberculosis after LT has atypical clinical manifestations and is easily misdiagnosed or delayedly diagnosed. It can be well cured by anti-TB treatment with close monitoring of liver damage and graft rejection.