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Diagnosis of tuberculosis infection in patients awaiting transplantation

Abstract number: O333

Casas S., Muñoz L., Andreu A., Moure R., Castellote J., Arnan M., Guerra M.R., Gonzalez L., Alcaide F., Rafecas A., Duarte R., Peralta T., Santin M.

Objectives: To compare the tuberculin skin test (TST) with the QuantiFERON® TB Gold-in Tube (QFT-GIT) for the diagnosis of tuberculosis infection (TBI) in patients prior to transplantation.

Methods: A prospective, cross-sectional study of the patients evaluated for liver and haematopoietic progenitor transplantation in a teaching hospital in Spain, from July 2008 to September 2009. Simultaneous QFT-GIT and two steps TST were performed.

Results: 92 patients were screened for TBI, 69 (75%) candidates to liver transplantation (LT) and 23 (25%) to haematopoietic progenitor transplantation (HPT). Sixty (65.2%) were men, mean age of 55 years. Fifty two (56.2%) presented some risk factor for TBI and 23 (25%) had BCG-vaccination. In the LT group, 67 (97.1%) patients were diagnosed with cirrhosis with a mean MELD score of 13.8. In the HPT group, 21 (91.3%) patients had received chemotherapy, at least, in the previous 6 months. Thirty eight (41.3%) patients had a positive TST (35 with the 1st TST and only 3 with the 2nd one), and also 38 (41.3%) had a positive QFT-GIT. Among LT patients, there were 31 (44.9%) positive TST and 31 (44.9%) positive QFT-GIT results, and among HPT patients 7 (30.4%) positive TST and 7 (30.4%) positive QFT-GIT results. In the LT group, a MELD score >18 (OR 0.09, CI95% 0.02–0.55; p = 0.01) and albumin <30 (OR 0.23, CI95% 0.07–0.82; p = 0.02) were associated with a lower likelihood of positive TST but not with QFT-GIT results. Discordant results were observed in 11 QFT-GIT+/TST- patients and in 11 QFT-GIT-/TST+. QFT1-GIT+/TST- results were associated with MELD score >18 (9.8, CI95% 1.6–62; p = 0.02). There were only 3 (3.3%) indeterminate QFT-GIT results.

Conclusions: QFT-GIT and TST are both feasible tests for diagnosing TBI in patients considered for LT and HPT. Higher MELD score and hypoalbuminemia were associated with a lower likelihood of positive TST, but not with QFT-GIT.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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