Tuberculin Positivity: A Serious Problem Before Transplantation in Turkey

Kantarcı, Gülçin; Altinoz, Hilal; Şahin, Sevgi; Manga, G. Pérez; Taşan, Güralp

doi:10.1016/j.transproceed.2006.02.008

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…And 14.5% of positives had a previous TB history. 7 Besides, in a recent Spanish cohort, authors demonstrated that only 0.9% of patients with a positive tuberculin test developed TB, therefore tuberculin test positivity was not found to be a risk factor. But they could not rule out the possibility that this finding was due to a lack of statistical power so they kept the current recommendations for chemoprophylaxis for high risk patients who were described by tuberculin test positivity, co-residence with a person with active TB, and inappropriately treated TB.…”

Section: Discussionmentioning

confidence: 95%

“…2 Tuberculin skin test has several limitations in diagnosis of latent TB infection since cutaneous anergy rate due to underlying immunosuppression and false positivity due to exposure to non-TB mycobacteria or prior bacille CalmetteGuérin vaccination among these patients are high. 2,7 This study was undertaken to report the experience with posttransplantation TB in a single center.…”

Section: Introductionmentioning

confidence: 99%

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Tuberculosis in Renal Transplant Recipients

et al. 2011

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Background: Renal transplant recipients should be considered at high risk for development of Mycobacterium tuberculosis infection (tuberculosis, TB). TB is relatively more frequent among transplant recipients than general population, depending on its epidemicity in the geographic region. Clinical manifestations in this group of patients may be atypical and deserve aggressive investigations for diagnosis. Tuberculin skin test has several limitations regarding diagnosis in chronic renal failure patients. In this retrospective study, we aimed to explore the prevalence and clinical manifestations of TB in renal transplant patients. Materials and methods: We retrospectively analyzed the data for TB prevalence, clinical presentations, and patient and graft survivals of total 320 pediatric and adult renal transplant recipients in our center between 1992 and 2010. Results: The prevalence of TB was 2.8%. Five patients received kidney from living-donor related and four from cadaveric donors. Cadaveric-donor patients received antithymocyte globulin for induction, and four patients received pulse steroid for acute rejection. The median duration of time between transplantation and TB was 21 (1-150) months, and between induction/pulse therapy and infection was 5 (1-100) months. The immunosuppressive protocols included prednisolone and cyclosporine/rapamycin with or without mycophenolate mofetil/azathioprine. The major symptoms were fever (77%), cough (66%), and abdominal pain (22%). Extrapulmonary TB with intestinal (2/9), pericardial (1/9), lymph node (1/9), and cerebral (1/9) involvements developed in five patients. One patient had both pulmonary and testicular involvements. All patients received quartet of anti-TB therapy for a median duration of 9 months. One patient died at the second month of therapy because of dissemination of TB, and one patient returned to hemodialysis because of chronic allograft nephropathy. Conclusion: The prevalence of TB was 2.8% in our renal transplant patients. The quartet of anti-TB treatment including rifampicin resulted in success in a majority of patients.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Tuberculosis in Renal Transplant Recipients

et al. 2011

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“…[16172024] But its relevance in terms of treatment or future development of active disease has not been evaluated. Some of the factors attributed in different studies increasing TST positivity are male sex,[2025] elderly patients,[23] past history of TB[17] and better nutrition. [19] In this study nearly 80% patients were males and only 5-8% patients had history of past TB.…”

Section: Discussionmentioning

confidence: 99%

Tuberculin skin test for the diagnosis of latent tuberculosis during renal replacement therapy in an endemic area: A single center study

et al. 2010

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Patients on renal replacement therapy (RRT) are at-risk for developing tuberculosis (TB). There is limited information on tuberculin skin test (TST) and its predictability for development of TB. In this prospective cohort study, patients taken for RRT were included. Patients with active TB were excluded. TST was done with 5-tuberculin unit. In addition to TST, age, sex, diabetes as basic disease, number of dialysis and blood transfusion (BT), pre-transplant TB, hepatitis B and C infections and type of immunosuppression were correlated with the development of TB. Of the 200 patients included, TST was positive in 21 and negative in 179. In TST negative group, 20 (11.1%) and in TST positive group 5 (23.8%) patients developed TB. TB free survival in two groups was similar (P = 0.08). On multivariate Cox regression analysis, hazard of development of TB by TST was 2.7 [P = 0.11, confidence interval (CI) 0.78-9.7]. There was no difference between TST non-responsive and TST negative patients (P = 0.18). Sensitivity and specificity of TST for predicting TB was only 20 and 9%, respectively. Our study shows that TST in patients on dialysis is an insensitive and nonspecific test to predict development of active TB.

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“…34 Previous studies reported a high rate of cutaneous anergy (40-58%) in CRF patients due to altered cellular immune response when compared with healthy subjects. 12,20,35,36 In our study, CRF patients had an anergy response approximately 10 times higher than IC patients with TST. On the other hand, response to PHA mitogen is accepted as a surrogate marker for in vitro anergy and a determinant of the quality control of the IGRA assay.…”

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confidence: 43%