Poor predictability of QuantiFERON-TB assay in recipients and donors for tuberculosis development after kidney transplantation in an intermediate-TB-burden country

Jambaldorj, Enkthuya; Jeong, Jong Cheol; Koo, Tai Yeon; Min, Sang Il; Song, Eun Young; Ha, Jong‐Won; Ahn, Curie; Yang, Jaeseok

doi:10.1186/s12882-017-0506-9

Cited by 11 publications

(4 citation statements)

References 21 publications

(30 reference statements)

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“…Among the included studies, 36 used one or more variants of the QFT assay, including individuals sampled with QFT Gold (n=8262) [29,36,48,58,59,70,78,83,94], QFT-GIT (n=56 327) [13, 28, 39, 42, 45, 49, 51, 57, 60, 67, 71, 72, 79-81, 83, 86-88, 93, 96, 104-107, 110, 113] and a single study using QFT-Plus (n=829) [89]. Seven studies used T-SPOT.TB (n=5547) [31,62,65,72,90,104,114] and two of these included simultaneous QFT-GIT [72,104].…”

Section: Resultsmentioning

confidence: 99%

The global prevalence of latent tuberculosis: a systematic review and meta-analysis

et al. 2019

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In 1999, the World Health Organization (WHO) estimated that one-third of the world's population had latent tuberculosis infection (LTBI), which was recently updated to one-fourth. However, this is still based on controversial assumptions in combination with tuberculin skin test (TST) surveys. Interferon-γ release assays (IGRAs) with a higher specificity than TST have since been widely implemented, but never used to estimate the global LTBI prevalence.We conducted a systematic review and meta-analysis of LTBI estimates based on both IGRA and TST results published between 2005 and 2018. Regional and global estimates of LTBI prevalence were calculated. Stratification was performed for low, intermediate and high TB incidence countries and a pooled estimate for each area was calculated using a random effects model.Among 3280 studies screened, we included 88 studies from 36 countries with 41 IGRA (n=67 167) and 67 TST estimates (n=284 644). The global prevalence of LTBI was 24.8% (95% CI 19.7–30.0%) and 21.2% (95% CI 17.9–24.4%), based on IGRA and a 10-mm TST cut-off, respectively. The prevalence estimates correlated well to WHO incidence rates (Rs=0.70, p<0.001).In the first study of the global prevalence of LTBI derived from both IGRA and TST surveys, we found that one-fourth of the world's population is infected. This is of relevance, as both tests, although imperfect, are used to identify individuals eligible for preventive therapy. Enhanced efforts are needed targeting the large pool of latently infected individuals, as this constitutes an enormous source of potential active tuberculosis.

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Section: Resultsmentioning

confidence: 99%

The global prevalence of latent tuberculosis: a systematic review and meta-analysis

et al. 2019

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“…Among the 34 patients who underwent a T-spot test in the present study, 28 (58.3%) cases were positive and the other 6 cases (12.5%) were T-spot negative. Both T-spot and TST may yield false-negative or indeterminate results in patients receiving high levels of immunosuppressive drugs[ 23 – 24 ]. Therefore, the results should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic delay and mortality of active tuberculosis in patients after kidney transplantation in a tertiary care hospital in China

Yang

et al. 2018

PLoS ONE

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TB infection in patients after kidney transplantation remains a concern in a successful long-term outcome. This retrospective, descriptive study was performed on tuberculosis infection after kidney transplantation in the Department of Infectious Disease of the First Affiliated Hospital of Zhejiang University, a tertiary care hospital in China, from January 2011 to April 2017, with the aim to explain the clinical features of active tuberculosis after kidney transplantation and explore the correlated factors for diagnostic delay and mortality. It included 48 cases. All these cases were followed up for at least 12 months after anti-tuberculosis therapy, except the ones who died during this period. The median time of transplantation to active tuberculosis of these 48 patients was about 5.4 years. The time from a first hospital visit to the diagnosis (diagnostic delay) of 12 (25%) cases was more than 30 days. The correlated factors for the diagnostic delay more than 30 days were a fever for more than 2 weeks and antibiotic use for more than 2 weeks. Nine (18.8%) cases died during the anti-tuberculosis therapy or following-up period due to TB relapse. The risk factors for mortality were severe complications, such as encephaledema, severe pneumonia, intestinal perforation, liver function failure, and the following multiple-organ failure. In conclusion, the possibility of tuberculosis infection should be carefully assessed and sometimes diagnostic anti-tuberculosis therapy may be required for patients who had a fever for more than 2 weeks or used antibiotics for more than 2 weeks after kidney transplantation. Severe complications and the following multiple-organ failure might increase the mortality among these patients.

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“…However, TST was not associated with clinically latent TB, and agreement between TST and QFT in these 138 KT recipients was poor (κ = 0.327). [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Agreement between the results of tuberculin skin test and Interferon-Gamma Release Assays in renal transplant candidates

et al. 2021

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Introduction: Identification of latent tuberculosis (TB) infection is important in kidney transplant candidates. Due to the absence of a gold standard, both tuberculin skin test (TST) and interferon-gamma release assays (IGRA) are used to screen patients. The aim of this study was to evaluate the agreement of these two tests in patients undergoing renal transplantation. Materials and Methods: Two hundred kidney transplant candidates at a referral center in 2014–2017 were included in this study. TST and Quantiferon-Gold (QFT-G) tests were performed for all patients before transplantation. In case of a positive result in any of the tests, patients were administered a 9-month prophylaxis treatment using isoniazid. Cohen's kappa coefficient (k) test was used to determine the agreement between the two tests. Results: The mean age of patients was 40.72 ± 18.33. Nine (4.5%) patients had positive TST and 16 (8%) had positive IGRA. Concordance of the two tests was evaluated as medium (κ = 0.44 and P < 0.001). No association was found between the underlying causes of renal failure and skin test positive or IGRA. The tests showed a poor agreement among diabetics, candidates of re-transplantation, and those who were on dialysis for longer than a year (κ < 0.20). Conclusion: TST or IGRA can be used to screen TB in kidney transplant candidates with a moderate agreement. However, we suggest using both TST and QFT-G in diabetics, re-transplant candidates, and those on dialysis for >1 year.

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Poor predictability of QuantiFERON-TB assay in recipients and donors for tuberculosis development after kidney transplantation in an intermediate-TB-burden country

Cited by 11 publications

References 21 publications

The global prevalence of latent tuberculosis: a systematic review and meta-analysis

The global prevalence of latent tuberculosis: a systematic review and meta-analysis

Diagnostic delay and mortality of active tuberculosis in patients after kidney transplantation in a tertiary care hospital in China

Agreement between the results of tuberculin skin test and Interferon-Gamma Release Assays in renal transplant candidates

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