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Infection

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Latent tuberculosis infection in transplant candidates: a systematic review and meta-analysis on TST and IGRA

  • Mohammad Javad NasiriEmail author
  • Ali Pormohammad
  • Hossein Goudarzi
  • Masoud Mardani
  • Samin Zamani
  • Giovanni Battista Migliori
  • Giovanni Sotgiu
Review
  • 159 Downloads

Abstract

Introduction

The diagnostic accuracy of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) for latent tuberculosis infection (LTBI) in transplant candidates is uncertain.

Methods

Pubmed, Embase and Cochrane library were searched to identify relevant studies. Quality of included studies was assessed with RevMan5 software (via GUADAS2 checklist). Accuracy measures of IGRAs and TST assays (sensitivity, specificity and others) were pooled with random effects model. Data were analyzed by STATA and Meta-DiSc.

Results

Twenty-eight studies were selected for full review, and 16 were included in the final analysis. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) for TST were 46% [95% confidence interval (CI) 38–54%], 86% (95% CI 75–93%), 46.3% (95% CI 40–52), 88.7% (95% CI 87–89), 3.3 (95% CI 1.6–6.4), 0.63 (95% CI 0.52–0.77) and 5 (95% CI 2–12), respectively. For QFT-G, the pooled sensitivity, specificity, PPV, NPV, PLR, NLR, and DOR were 58% (95% CI 41–73%), 89% (95% CI 77–95%), 72.7% (95% CI 68–76), 80.6% (95% CI 78–82), 5.3 (95% CI 2.0–14.0), 0.47 (95% CI 0.30–0.75) and 11 (95% CI 3–46), respectively. Likewise, for T-SPOT.TB, the pooled sensitivity, specificity, PPV, NPV, PLR, NLR, and DOR were 55% (95% CI 40–70%), 92% (95% CI 87–95%), 60.4% (95% CI 47–72), 90.2% (95% CI 86–92), 6.7 (95% CI 4.0–11.1), 0.52 (95% CI 0.31–0.85) and 16 (95% CI 7–37), respectively.

Conclusions

IGRAs were more sensitive and specific than the TST with regard to the diagnosis of LTBI in the transplant candidates. They have added value and can be complementary to TST.

Keywords

Latent tuberculosis infection (LTBI) Interferon-gamma release assays (IGRAs) Tuberculin skin test (TST) Transplantation 

Notes

Acknowledgements

The paper is part of the operational research plan of the WHO Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, ITA-80, 2017-2020-GBM/RC/LDA.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Microbiology, School of MedicineShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Infectious Diseases and Tropical Medicine Research CenterShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Infectious Diseases Research CenterGolestan University of Medical SciencesGorganIran
  4. 4.Istituti Clinici Scientifici Maugeri IRCCSTradateItaly
  5. 5.Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental SciencesUniversity of SassariSassariItaly

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