Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control. (4th July 2020)

• Record Type: Journal Article
• Authors: Shu, Chin-Chung; Tsai, Meng-Kun; Lin, Shu-Wen; Wang, Jann-Yuan; Yu, Chong-Jen; Lee, Chih-Yuan
• Is Part Of: Clinical infectious diseases. Volume 71:Number 4(2020)
• Page Start: 914
• Page End: 923
• Publication Date: 2020-07-04
• Subjects: latent tuberculosis infection -- kidney transplantation -- QuantiFERON-TB Gold In-tube -- conversion -- tuberculosis; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciz851
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: The prevalence and incidence of latent tuberculosis infection (LTBI) in patients with kidney transplantation remain unclear. Methods: In this prospective study, we enrolled kidney transplantation candidates (KTCs) and recipients (KTRs) from 2014 to 2018. We defined LTBI as a positive result of QuantiFERON-TB Gold In-tube (QFT). We analyzed the predictors for LTBI acquisition and followed up on QFT assay test for 2 years among those initially without LTBI. Results: Of 425 patients enrolled, 305 (71.8%) patients belonged to the KTC group and 120 (28.2%) to the KTR group. The initial QFT showed positive results in 32 (10.5%) and 24 (20.0%) patients in the KTC and KTR groups, respectively ( P = .009). The QFT response value in patients with LTBI was higher in the KTR group than in the KTC group (1.85 vs 1.06 IU/mL, P = .046). Multivariate logistic regression showed that old age, absence of bacillus Calmette–Guérin (BCG) scar, presence of donor-specific antibody, and KTR group were independent factors for positive LTBI. For participants with initial negative QFT, positive QFT conversion within a 2-year follow-up was higher after kidney transplantation (20%) than in KTCs (5.5%) ( P = .034). Conclusions: This study is the first cohort to follow up LTBI status in patients with kidney transplantation and shows its higher prevalence and incidence in KTRs. It indicates that surveillance of LTBI after renal transplantation is important. In addition to status of kidney transplantation, old age, no BCG vaccination, and positive donor-specific antibody are also positive predictors for LTBI. Abstract : The present study found a higher prevalence and incidence of latent tuberculosis infection (LTBI) in kidney transplantation recipients than in kidney transplantation candidates. This indicates that surveillance and control of LTBI after kidney transplantation are important.