Tests for latent tuberculosis in candidates for solid organ transplantation: A systematic review and meta‐analysis

Abstract

Reactivation of latent tuberculosis following solid organ transplantation has serious consequences for the recipient. The most useful diagnostic test for latent TB is not clear. We conducted a systematic review and meta-analysis to assess the relative test performance of interferon gamma release assays (IGRAs) and the tuberculin skin test (TST) in people undergoing solid organ transplantation. The clinical or radiological risk factors were used as the proxy reference standard. Test performance was expressed as an odd ratio (OR). We identified 24 studies (N = 7811), 12 studies compared IGRAs with TST directly, nine studies evaluated only TST and three studies only IGRAs. Direct comparison between tests and clinical risk factors indicated both tests were strongly associated with the presence of clinical risk factors for TB (TST: OR 3.17; 95%CI 1.55-6.48, IGRA: OR 2.78; 95%CI 1.55-5.01), and radiological evidence of past TB (TST: OR 3.26; 95%CI 1.85-5.73, IGRA: OR 3.85; 95%CI 2.16-6.86). Relative comparison indicated IGRAs positivity was more strongly associated with presence of radiological evidence of TB than TST (relative OR: 3.24; 95%CI 1.10-9.56). While there is no strong evidence in supporting use of IGRAs over TST for diagnosing latent TB, IGRAs positivity is more associated with the presence of radiological evidence of previous TB. K E Y W O R D S interferon gamma release assay, latent tuberculosis, solid organ transplantation, testing, tuberculin skin test S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Maung Myint T, Rogerson TE, Noble K, Craig JC, Webster AC. Tests for latent tuberculosis in candidates for solid organ transplantation: A systematic review and meta-analysis. Clin Transplant. 2019;33:e13643.

Diagnostic Value of Interferon-Gamma Release Assays for Tuberculosis in the Immunocompromised Population

“…Most international guidelines recommend screening for LTBI in all kinds of SOT candidates/donors, and both the TST and IGRAs are recommended as screening tools. Different studies showed great differences in the diagnostic value of the TST and IGRAs, which may be due to different immunosuppressive states caused by various organ failures [ 79 ]. A study showed that the sensitivity of the TST was surprisingly low in this population, with only 20–25% of post-transplant ATBI cases having a positive response to the TST before SOT [ 80 ].…”