Comparison of Quantiferon-TB Gold With Tuberculin Skin Test for Detecting Latent Tuberculosis Infection Prior to Liver Transplantation

Manuel, Oriol; Humar, Atul; Preiksaitis, Jutta; Doucette, Karen; Shokoples, Sandy; Peleg, Anton Y.; Cobos, Isabel; Kumar, Deepali

doi:10.1111/j.1600-6143.2007.02011.x

Cited by 108 publications

(123 citation statements)

References 20 publications

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“…Interferon-gamma release assays have been tested and found to perform reasonably well in healthy populations as well as in patients with end-stage liver disease. [16][17][18][19] …”

Section: Diagnosis Of Tuberculosis In End-stage Liver Diseasementioning

confidence: 99%

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Dhiman

Saraswat

Rajekar

et al. 2012

Journal of Clinical and Experimental Hepatology

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Tuberculosis remains one of the 'Captains of the Men of Death' even today, particularly in the developing world. Its frequency is increased 14-fold in patients with chronic liver diseases (CLD) and liver cirrhosis, more so in those with decompensated disease, probably due to the cirrhosis-associated immune dysfunction syndrome, and case-fatality rates are high. The diagnosis of tuberculosis, particularly the interpretation of the Mantoux test, is also fraught with difficulties in CLD, especially after previous BCG vaccination. However, the greatest challenge in the patient with CLD or liver cirrhosis and tuberculosis is managing their therapy since the best first-line anti-tuberculosis drugs are hepatotoxic and baseline liver function is often deranged. Frequency of hepatotoxicity is increased in those with liver cirrhosis, chronic hepatitis B and chronic hepatitis C, possibly related to increased viral loads and may be decreased following antiviral therapy. If hepatotoxicity develops in those with liver cirrhosis, particularly decompensated cirrhosis, the risk of severe liver failure is markedly increased. Currently, there are no established guidelines for anti-tuberculosis therapy (ATT) in CLD and liver cirrhosis although the need for such guidelines is self-evident. It is proposed that ATT should include no more than 2 hepatotoxic drugs (RIF and INH) in patients with CLD or liver cirrhosis and stable liver function [ChildTurcotte-Pugh (CTP) #7], only a single hepatotoxic drug (RIF or INH) in those with advanced liver dysfunction and no hepatotoxic drugs with very advanced liver dysfunction (CTP $11). A standard protocol should be followed for monitoring ATT-related hepatotoxicity and for stop rules and reintroduction rules in all these patients, on the lines proposed here. It is hoped that these proposals will introduce uniformity and result in streamlining the management of these difficult patients. ( J CLIN EXP HEPATOL 2012;2:260-270)

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“…Interferon-gamma release assays have been tested and found to perform reasonably well in healthy populations as well as in patients with end-stage liver disease. [16][17][18][19] …”

Section: Diagnosis Of Tuberculosis In End-stage Liver Diseasementioning

confidence: 99%

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Dhiman

Saraswat

Rajekar

et al. 2012

Journal of Clinical and Experimental Hepatology

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“…Concordance between the 2 tests was 85.1% (k ¼ 0.60), and this suggests that QFT was comparable to PPD for the diagnosis of latent TB in this population. 12 Another study comparing QFT to PPD testing in patients with chronic liver disease revealed fewer positive results with PPD testing. 13 Currently, there is no reported advantage for one test versus the other; but in normal hosts, interferon-c release assays have the advantage of differentiating people whose positive skin test reflects prior vaccination against Bacille Calmette-Guérin (BCG) infection.…”

Section: Diagnosis Latent Tbmentioning

confidence: 99%

“…[14][15][16] Because both QFT and TST measure the cellular immune response to M. tuberculosis, testing with QFT is unlikely to be helpful in patients with a negative TST related to defective cellular immune responses. 11,12 The full evaluation of a patient with cirrhosis before liver transplantation should be thorough and include a detailed medical and exposure history and a review of chest radiography (see the section on the evaluation of transplant candidates and donors). In posttransplant recipients, the diagnosis of LTBI similarly involves the use of TST or interferon-c release assay testing.…”

Section: Diagnosis Latent Tbmentioning

confidence: 99%

Mycobacterium tuberculosis infection in liver transplantation

Yehia

Blumberg

2010

Liver Transpl

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Mycobacterium tuberculosis can cause significant infections in liver transplant candidates and recipients. Its nonspecific clinical features and prolonged growth time in culture make the diagnosis difficult, and treating tuberculosis (TB) remains challenging because of significant toxicities and drug-drug interactions. The diagnosis of a latent TB infection may be accomplished with tuberculin skin testing and with the newer interferon-c release assays, although this infection may be underrecognized because of host factors. Latent TB should be treated, but the degree of liver failure and the likelihood of progression to active TB will dictate whether this should occur before or after transplantation. Patients who have a history of TB, have used muromonab-CD3 or anti-T lymphocyte antibodies, or have experienced allograft rejection or coinfection with cytomegalovirus, Pneumocystis jiroveci, or Nocardia are at the greatest risk of developing active TB. Active TB in transplant patients is difficult to treat because of drug-induced hepatotoxicity and the significant interaction between rifampin and calcineurin inhibitors. In this article, we review the epidemiology, clinical features, and evaluation of transplant candidates and recipients. In addition, we offer recommendations on the appropriate diagnostic and treatment regimens for patients with latent and active TB infections. Liver Transpl 16:1129-1135, 2010. V C 2010 AASLD.Received April 5, 2010; accepted July 6, 2010.Tuberculosis (TB) is a serious global infection with an estimated prevalence of 13.7 million cases worldwide. 1 Transplant recipients have a 36-to 74-fold higher risk of developing TB versus the general population. 2 TB in liver transplant recipients presents unique challenges, including a delayed diagnosis secondary to insensitive testing and treatment complications due to antituberculous drug toxicities and interactions with immunosuppressive agents. This review focuses on the epidemiology, clinical features, diagnosis, clinical evaluation, and treatment of liver transplant patients infected with TB. EPIDEMIOLOGYRates of 0.47% to 2.3% for active TB in adult liver transplant recipients has been reported. [2][3][4][5] Because of the difficulty of accurately diagnosing symptomatic TB, these figures most likely underestimate the burden of the disease. In addition, the frequency of the disease varies geographically, with particular regions (Asia and Africa) having a higher prevalence than other areas of the world. 6 Several factors place transplant patients at greater risk of developing active TB.A previous TB infection increases the likelihood of TB developing after transplantation. 5 The RESITRA (Spanish Network of Infection in Transplantation) cohort documented a relative risk of 4.3 for the development of symptomatic TB when the purified protein derivative (PPD) test was positive instead of negative. 4 In a systematic review of 139 cases of active TB infection after liver transplantation, 37% had a positive tuberculin skin test (TST), 23% had abnorm...

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“…When screening recipients, the decrease in test sensitivity with increasing immunosuppression has important practical consequences, as screening should be carried out before administration of immunosuppressive drugs to ensure sensitivity and to allow sufficient time to initiate chemoprophylaxis. Studies in transplant candidates prior to liver [62,63] or renal transplantation indicate that IGRAs may be applied, although agreement between TST and IGRAs in renal transplant candidates is only fair to moderate [64][65][66][67][68].…”

Section: Risk Of Tb In Sot Recipientsmentioning

confidence: 99%

“…Whilst neither M. bovis BCG nor most environmental mycobacteria influence the result of IGRAs, data regarding their value in immunosuppressed children and young children are lacking. Studies evaluating IGRAs in transplant candidates to date have excluded children [62,63].…”

Section: Diagnosis Of Infection With M Tuberculosismentioning

confidence: 99%

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

234

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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Comparison of Quantiferon-TB Gold With Tuberculin Skin Test for Detecting Latent Tuberculosis Infection Prior to Liver Transplantation

Cited by 108 publications

References 20 publications

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Mycobacterium tuberculosis infection in liver transplantation

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

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