Latent Tuberculosis Infection Increases in Kidney Transplantation Recipients Compared With Transplantation Candidates: A Neglected Perspective in Tuberculosis Control

Chin-Chung Shu, Meng-Kun Tsai, Shu-Wen Lin, Jann-Yuan Wang, Chong-Jen Yu, Chih-Yuan Lee, Chin-Chung Shu, Meng-Kun Tsai, Shu-Wen Lin, Jann-Yuan Wang, Chong-Jen Yu, Chih-Yuan Lee

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.

Keywords: QuantiFERON-TB Gold In-tube; conversion; kidney transplantation; latent tuberculosis infection; tuberculosis.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Flow chart of participant enrollment. Abbreviations: QFT, QuantiFERON-TB Gold In-tube; TB, tuberculosis.
Figure 2.
Figure 2.
The follow-up results of QFT for participants with initial negative QFT according to kidney transplantation status. A, The new positive QFT number. B, The percentage of positive conversion. Abbreviations: KTC, kidney transplantation candidate; KTR, kidney transplantation recipient; m, months; QFT, QuantiFERON-TB Gold In-tube.

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