Latent tuberculosis screening before kidney transplantation in the South of Brazil

Abstract

Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

Kidney transplantation in patients on anti‐tubercular therapy: A single centre observational study

“…There is a paucity of data on the prevalence of active TB in patients being referred for pre‐transplant evaluation and the subsequent delay in their transplantation. Although screening for latent TB infection (LTBI) is not routinely practiced in India, studies 8–10 from other countries reveal a high rate of LTBI in renal transplant candidates. However, there is a dearth of data so far on organ transplantation in patients with active TB.…”

Indicação do tratamento da tuberculose latente: desafios identificados no sistema de notificação brasileiro, 2018-2022

“…Até o momento, é sabido que ainda não existe um teste "padrão-ouro" para identificação da ILTB 18 . Sua detecção é presumida pela imunosensibilização prévia do indivíduo ao antígeno da bactéria e na ausência de manifestações clínicas e radiológicas da forma ativa (18) , o que pode culminar em confusão diagnóstica.…”

“…Até o momento, é sabido que ainda não existe um teste "padrão-ouro" para identificação da ILTB 18 . Sua detecção é presumida pela imunosensibilização prévia do indivíduo ao antígeno da bactéria e na ausência de manifestações clínicas e radiológicas da forma ativa (18) , o que pode culminar em confusão diagnóstica. Somado a isso, apontam-se as dificuldades com relação ao tratamento, que, por vezes, se limita pela baixa adesão frente à duração prolongada e aos efeitos adversos 19 .…”