Diagnostic potential of interferon‐gamma release assay to detect latent tuberculosis infection in kidney transplant recipients

Edathodu, Jameela; Varghese, Bright; Alrajhi, Abdulrahman A.; Shoukri, Mohammed; Nazmi, Ahmad; Elgamal, Hazem; Aleid, Hassan; Alrabiah, Fahad; Ashraff, Aattia; Mahmoud, Ihab; Al‐Hajoj, Sahal

doi:10.1111/tid.12675

Cited by 22 publications

(24 citation statements)

References 20 publications

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“…This is the first approved biological agent for chronic use for prophylaxis of acute rejection after KT -a type of treatment regimen that has been associated with an increased risk of TB infection. 15 It is unknown whether the costimulation blockage induced by belatacept is associated with reduced granuloma forma- 16,22,23 In low-burden countries, clinical and radiological suspicion is insufficient to define TB cases, and the decision not to institute empirical therapy is a reasonable option. 15 It is unknown whether the costimulation blockage induced by belatacept is associated with reduced granuloma forma- 16,22,23 In low-burden countries, clinical and radiological suspicion is insufficient to define TB cases, and the decision not to institute empirical therapy is a reasonable option.…”

Section: Discussionmentioning

confidence: 99%

“…In countries with high TB burdens, it is mandatory to consider TB diagnosis and treat such patients. 16,22,23 In low-burden countries, clinical and radiological suspicion is insufficient to define TB cases, and the decision not to institute empirical therapy is a reasonable option. 7,8 In our study, identification of patients at risk for LTBI was challenging.…”

Section: Only 41% Of Our Patients Developed Tb Within 1 Year After Trmentioning

confidence: 99%

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Influence of epidemiology, immunosuppressive regimens, clinical presentation, and treatment on kidney transplant outcomes of patients diagnosed with tuberculosis: A retrospective cohort analysis

Viana

Cristelli

Santos

et al. 2019

American Journal of Transplantation

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Tuberculosis (TB) mortality is high among kidney transplant (KT) recipients. Although local epidemiology is an important factor, diagnostic/therapeutic challenges and immunosuppressive therapy (ISS) may influence outcomes. We analyzed the cumulative incidence (CumI) of TB in KT recipients receiving a variety of ISS with long-term follow-up. Our retrospective single-center cohort study included all KT procedures performed between January 1, 1998, and August 31, 2014, with follow-up until August 31, 2014. Induction therapy was based on perceived immunological risk; maintenance ISS included prednisone and calcineurin inhibitor (CNI) plus azathioprine (AZA), and mycophenolic acid (MPA) or mechanistic target of rapamycin inhibitor (mTORi). Thirty-four patients received belatacept/MPA. KT was performed on 11 453 patients and followed for 1989 (IQR 932 to 3632) days. Among these, 152 patients were diagnosed with TB (CumI 1.32%). Median time from KT to TB was 18.8 (IQR 7.2 to 60) months, with 59% of patients diagnosed after the first year. Unadjusted analysis revealed an increasing confidence interval (CI) of TB (0.94% CNI/AZA vs 1.6% CNI/MPA [HR = 1.62, 95% CI = 1.13 to 2.34, P = .009] vs 2.85% CNI/mTORi [HR = 2.45, 95% CI = 1.49 to 4.32, P < .001] vs 14.7% belatacept/MPA [HR = 13.14, 95% CI = 5.27 to 32.79, P < .001]). Thirty-seven (24%) patients died, and 39 (25.6%) patients experienced graft loss. Cytomegalovirus infection (P = .02) and definitive ISS discontinuation (P < .001) were associated with death. Rejection (P = .018) and ISS discontinuation (P = .005) occurred with graft loss. TB occurred at any time after KT and was influenced by ISS. K E Y W O R D S clinical research/practice, complication: infectious, immunosuppressant -fusion proteins and monoclonal antibodies: belatacept, infection -mycobacterial, infection and infectious agents, infectious disease, kidney transplantation/nephrology

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Section: Discussionmentioning

confidence: 99%

Section: Only 41% Of Our Patients Developed Tb Within 1 Year After Trmentioning

confidence: 99%

Influence of epidemiology, immunosuppressive regimens, clinical presentation, and treatment on kidney transplant outcomes of patients diagnosed with tuberculosis: A retrospective cohort analysis

Viana

Cristelli

Santos

et al. 2019

American Journal of Transplantation

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“…11). Interferon-gamma releasing assay (IGRA) for Mycobacterium tuberculosis (TB) enabled the diagnosis of latent TB infection or recent TB exposure (35).…”

Section: The Need Of Further Immune Monitoring Testsmentioning

confidence: 99%

Results of Questionnaire Survey of Current Immune Monitoring Practice of Transplant Clinicians and Clinical Pathologists in Korea: Basis for Establishment of Harmonized Immune Monitoring Guidelines

Kang

Choi

Park

et al. 2018

Korean J Transplant

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Detection of significant alloimmune response, which affects graft function and survival by effective immune monitoring, is critical for treatment decision making. However, there is no consensus regarding immune monitoring (IM) for kidney transplantation (flow KT) in Korea. The IM protocol may be affected by the level of immunological risk, the methods of desensitization and the availabilities of resources such as laboratory support and cost of tests. Questionnaire surveys designed to identify the current practi- Until now, the immunological monitoring of alloimmune responses are focused on the detection of rejection events in practice than detection of adverse immune activity which might be preceded clinically or pathologically evident rejection signs. It might be rather because there were no reliable and well validated laboratory methods to be applicable.However, luminex bead technologies used for the detection of antibodies in antigen, allele or epitope levels for HLA(7-9) and non-HLA systems(15), and molecular technologies to detect transcript signatures of diverse immunologic changes are broadening our choice of tests(16-18).And it is continuously reflected on diagnostic criteria such as Banff criteria (19,20). However, the diagnostic criteria does not specify the practical way of immune monitoring in real world, so, there is no standardized guidelines and is Immune monitoring protocolsAbout 28% (9/32) of clinicians from 6 institutes (6/25, 24%) are performing protocol biopsies at various time points and the number of biopsy depending on the level of immunological risks (Fig. 3). When higher the risk, more frequent biopsies are being performed within posttransplant 12 weeks (Fig. 4). Clinicians are applying different combinations of HLA antibody tests in different time points and also depending on the level of immunological risks. Antibody monitoring is being performed frequently at posttransplant 3∼4 weeks, 24 weeks and yearly (Fig. 5). Antibody screening test is used for low risk patients, however for high risk patients, HLA antibody phenotyping or SAB identification tests are used more frequently (Fig. 6). The suggested time points of HLA antibody monitoring test in patients waiting for kidney transplantation was questioned regardless of current protocols (Fig. 7). Twenty-four out of 26 (92%) respondents answered that the presence of HLA antibody needed to be checked at registration in KONOS regardless of immunological risk levels, and for living donor kidney transplant (LDKT) candidates, it is suggested to do within pre-transplant 4 weeks. Twelve (46%) respondents replied that the monitoring of HLA antibody is necessary if the patients had recent transfusion or pregnancy episodes.As on-demand test when the rejection is suspected clinically, 70% (22/32) of respondents answered proceeding to HLA antibody test but 15% (5/32) answered to do HLA antibody test when the pathologic finding of AMR in biopsy identified (Fig. 8).2. sponses needs to be cautious because it may be rather because not all the instit...

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“…Our study shows that a relatively small number of individuals would need to undergo IPT prophylaxis if screening with IGRA was systemically applied and targeted to those at highest risk. However, given the issues with IGRA testing in immunocompromised populations, this test by itself may not be an adequate form of screening . Rather it may be more useful as one part of a multi‐faceted risk assessment.…”

Section: Discussionmentioning

confidence: 99%

“…However, given the issues with IGRA testing in immunocompromised populations, this test by itself may not be an adequate form of screening. [27][28][29] Rather it may be more useful as one part of a multi-faceted risk assessment. A reasonable approach to screening for renal transplant candidates would be initial risk assessment based on country of birth, and further screening with chest X-ray and IGRA for those from high-TB incidence countries.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium tuberculosis: Active disease and latent infection in a renal transplant cohort

et al. 2019

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Diagnostic potential of interferon‐gamma release assay to detect latent tuberculosis infection in kidney transplant recipients

Abstract: The agreement of the QFT with standard diagnosis of LTBI in kidney transplant recipients was poor.

Cited by 22 publications

References 20 publications

Influence of epidemiology, immunosuppressive regimens, clinical presentation, and treatment on kidney transplant outcomes of patients diagnosed with tuberculosis: A retrospective cohort analysis

Influence of epidemiology, immunosuppressive regimens, clinical presentation, and treatment on kidney transplant outcomes of patients diagnosed with tuberculosis: A retrospective cohort analysis

Results of Questionnaire Survey of Current Immune Monitoring Practice of Transplant Clinicians and Clinical Pathologists in Korea: Basis for Establishment of Harmonized Immune Monitoring Guidelines

Mycobacterium tuberculosis: Active disease and latent infection in a renal transplant cohort

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