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Infection

, Volume 41, Issue 1, pp 103–110 | Cite as

Comparison of the tuberculin skin test and interferon-γ release assay for the diagnosis of latent tuberculosis infection before kidney transplantation

  • S. Y. Kim
  • G. S. Jung
  • S. K. Kim
  • J. Chang
  • M. S. Kim
  • Y. S. Kim
  • Y. A. Kang
  • D. J. Joo
Clinical and Epidemiological Study

Abstract

Purpose

The evaluation of latent tuberculosis infection (LTBI) is recommended before kidney transplantation. The interferon-γ release assay has been reported to be more specific than the tuberculin skin test (TST) for detecting LTBI. We compared the TST and QuantiFERON-TB Gold In-Tube test (QFT-GIT) for the screening for LTBI and determined the agreement between the two tests in renal transplant recipients before transplantation.

Methods

Adult patients who were evaluated for renal transplantation between May 2010 and February 2012 at Severance Hospital in South Korea were prospectively enrolled. We performed TST and QFT-GIT.

Results

Of the 126 patients, 23 (19.3 %) had positive TST results and 53 (42.1 %) had positive QFT-GIT results. Agreement between the TST and QFT-GIT was fair (κ = 0.26, P < 0.001). The induration size of TST was significantly correlated with a positive rate of QFT-GIT (P = 0.015). Age (odds ratio [OR] 1.08, 95 % confidence interval [CI] 1.03–1.13, P = 0.003), male sex (OR 2.73, 95 % CI 1.17–6.38, P = 0.021), and risk for LTBI (OR 4.62, 95 % CI 1.15–18.64, P = 0.031) were significantly associated with positive QFT-GIT results. For positive TST results, only male sex was associated (OR 4.29, 95 % CI 1.40–13.20, P = 0.011).

Conclusion

The positivity for QFT-GIT was higher than the positivity for TST, and QFT-GIT more accurately reflected the risk for LTBI. However, a further longitudinal study is needed in order to confirm that the QFT-GIT test can truly predict the development of TB after renal transplantation.

Keywords

Latent tuberculosis Interferon-γ release assay Tuberculin skin test Kidney transplantation 

Notes

Acknowledgments

This work was supported by a grant of the Korean Health Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A101750).

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis. 1998;27:1266–77.PubMedCrossRefGoogle Scholar
  2. 2.
    Aguado JM, Torre-Cisneros J, Fortún J, et al. Tuberculosis in solid-organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology. Clin Infect Dis. 2009;48:1276–84.PubMedCrossRefGoogle Scholar
  3. 3.
    Muñoz P, Rodríguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis. 2005;40:581–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Benito N, Sued O, Moreno A, et al. Diagnosis and treatment of latent tuberculosis infection in liver transplant recipients in an endemic area. Transplantation. 2002;74:1381–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Subramanian A, Dorman S; AST Infectious Diseases Community of Practice. Mycobacterium tuberculosis in solid organ transplant recipients. Am J Transplant. 2009;9:S57–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Guidelines for the prevention and management of infectious complications of solid organ transplantation. Am J Transplant. 2004;4:37–41.Google Scholar
  7. 7.
    Sepulveda RL, Ferrer X, Latrach C, Sorensen RU. The influence of Calmette–Guérin bacillus immunization on the booster effect of tuberculin testing in healthy young adults. Am Rev Respir Dis. 1990;142:24–8.PubMedGoogle Scholar
  8. 8.
    Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis. 1993;17:968–75.PubMedCrossRefGoogle Scholar
  9. 9.
    Wang L, Turner MO, Elwood RK, Schulzer M, FitzGerald JM. A meta-analysis of the effect of Bacille Calmette Guérin vaccination on tuberculin skin test measurements. Thorax. 2002;57:804–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Menzies D. Interpretation of repeated tuberculin tests. Boosting, conversion, and reversion. Am J Respir Crit Care Med. 1999;159:15–21.PubMedGoogle Scholar
  11. 11.
    Pai M, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med. 2008;149:177–84.PubMedGoogle Scholar
  12. 12.
    Pai M, Riley LW, Colford JM Jr. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis. 2004;4:761–76.PubMedCrossRefGoogle Scholar
  13. 13.
    Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007;146:340–54.PubMedGoogle Scholar
  14. 14.
    Kobashi Y, Mouri K, Obase Y, Fukuda M, Miyashita N, Oka M. Clinical evaluation of QuantiFERON TB-2G test for immunocompromised patients. Eur Respir J. 2007;30:945–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Kim SH, Song KH, Choi SJ, et al. Diagnostic usefulness of a T-cell-based assay for extrapulmonary tuberculosis in immunocompromised patients. Am J Med. 2009;122:189–95.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim EY, Lim JE, Jung JY, et al. Performance of the tuberculin skin test and interferon-gamma release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population. BMC Infect Dis. 2009;9:207.PubMedCrossRefGoogle Scholar
  17. 17.
    Manuel O, Humar A, Preiksaitis J, et al. Comparison of quantiferon-TB gold with tuberculin skin test for detecting latent tuberculosis infection prior to liver transplantation. Am J Transplant. 2007;7:2797–801.PubMedCrossRefGoogle Scholar
  18. 18.
    Kim SH, Lee SO, Park IA, et al. Diagnostic usefulness of a T cell-based assay for latent tuberculosis infection in kidney transplant candidates before transplantation. Transpl Infect Dis. 2010;12:113–9.PubMedCrossRefGoogle Scholar
  19. 19.
    World Health Organization (WHO). Global tuberculosis control 2011. WHO report. 2011. http://www.who.int/tb/publications/global_report/en/.
  20. 20.
    Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003;167:603–62.PubMedCrossRefGoogle Scholar
  21. 21.
    American Thoracic Society/Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med. 2000;161:S221–47.Google Scholar
  22. 22.
    Korean Academy of Tuberculosis and Respiratory Diseases. Korean guidelines for tuberculosis. 2011.Google Scholar
  23. 23.
    Richeldi L, Losi M, D’Amico R, et al. Performance of tests for latent tuberculosis in different groups of immunocompromised patients. Chest. 2009;136:198–204.PubMedCrossRefGoogle Scholar
  24. 24.
    Chung WK, Zheng ZL, Sung JY, et al. Validity of interferon-gamma-release assays for the diagnosis of latent tuberculosis in haemodialysis patients. Clin Microbiol Infect. 2010;16:960–5.PubMedGoogle Scholar
  25. 25.
    Nienhaus A, Schablon A, Diel R. Interferon-gamma release assay for the diagnosis of latent TB infection—analysis of discordant results, when compared to the tuberculin skin test. PLoS One. 2008;3:e2665.PubMedCrossRefGoogle Scholar
  26. 26.
    Machado A Jr, Emodi K, Takenami I, et al. Analysis of discordance between the tuberculin skin test and the interferon-gamma release assay. Int J Tuberc Lung Dis. 2009;13:446–53.PubMedGoogle Scholar
  27. 27.
    Tzanno-Martins C, Futata E, Jorgetti V, Duarte AJ. Restoration of impaired T-cell proliferation after parathyroidectomy in hemodialysis patients. Nephron. 2000;84:224–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Chan TY. Vitamin D deficiency and susceptibility to tuberculosis. Calcif Tissue Int. 2000;66:476–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Girndt M, Sester U, Sester M, Kaul H, Köhler H. Impaired cellular immune function in patients with end-stage renal failure. Nephrol Dial Transplant. 1999;14:2807–10.PubMedCrossRefGoogle Scholar
  30. 30.
    Woeltje KF, Mathew A, Rothstein M, Seiler S, Fraser VJ. Tuberculosis infection and anergy in hemodialysis patients. Am J Kidney Dis. 1998;31:848–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Smirnoff M, Patt C, Seckler B, Adler JJ. Tuberculin and anergy skin testing of patients receiving long-term hemodialysis. Chest. 1998;113:25–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Richeldi L. An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med. 2006;174:736–42.PubMedCrossRefGoogle Scholar
  33. 33.
    Habesoğlu MA, Torun D, Demiroglu YZ, et al. Value of the tuberculin skin test in screening for tuberculosis in dialysis patients. Transplant Proc. 2007;39:883–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Soysal A, Toprak D, Koc M, Arikan H, Akoglu E, Bakir M. Diagnosing latent tuberculosis infection in haemodialysis patients: T-cell based assay (T-SPOT.TB) or tuberculin skin test? Nephrol Dial Transplant. 2012;27:1645–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Jiménez-Corona ME, García-García L, DeRiemer K, et al. Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area. Thorax. 2006;61:348–53.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • S. Y. Kim
    • 1
  • G. S. Jung
    • 1
  • S. K. Kim
    • 1
  • J. Chang
    • 1
  • M. S. Kim
    • 2
  • Y. S. Kim
    • 2
  • Y. A. Kang
    • 1
  • D. J. Joo
    • 2
  1. 1.Division of Pulmonology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Surgery, Research Institute for TransplantationYonsei University College of MedicineSeoulRepublic of Korea

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