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High rates of indeterminate interferon‐gamma release assays for the diagnosis of latent tuberculosis infection in liver transplantation candidates
Author(s) -
Wigg Alan J.,
Narayana Sumudu K.,
Anwar Shahzaib,
Ramachandran Jeyamani,
Muller Kate,
Chen John W.,
John Libby,
Hissaria Pravin,
Kaambwa Billingsley,
Woodman Richard J.
Publication year - 2019
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13087
Subject(s) - medicine , indeterminate , liver transplantation , latent tuberculosis , interferon gamma release assay , tuberculosis , liver disease , tuberculin , transplantation , quantiferon , odds ratio , gastroenterology , tuberculosis diagnosis , multivariate analysis , immunology , mycobacterium tuberculosis , pathology , mathematics , pure mathematics
Background and aims Screening for latent tuberculosis infection (LTBI) is recommended prior to solid organ transplantation. Interferon‐gamma release assays (IGRAs) are the most widely used test for LTBI screening; however, assessment of IGRA performance in patients with end‐stage liver disease is limited. The purpose of this study was to evaluate the prevalence and predictors of indeterminate (INDT) IGRA results in liver transplantation candidates. Methods Between March 2011 and May 2018, we retrospectively analyzed 155 patients undergoing liver transplantation assessment, who underwent IGRA testing (Quantiferon‐TB Gold, QFT‐G) to exclude LTBI. Characteristics of patients, including age, gender, etiology of liver disease, MELD score, and absolute lymphocyte counts, were compared by QFT‐G result (determinate vs INDT). Results Of the 155 patients screened, the rate of positive, negative, and INDT results were 5.2%, 69.8%, and 25%, respectively. The only variable independently associated with an indeterminate test on multivariate analysis was MELD score (odds ratio = 1.07, 95% CI = 1.01‐1.14 per unit increase; P = 0.014). In 95% of INDT tests, both TB antigen tube and the positive control tube were negative and repeat testing gave the same indeterminate result, suggestive of anergy rather than laboratory error. Conclusions Our study suggests a high rate of INDT IGRA results during screening of liver transplant candidates for LTBI, associated with severity of liver disease and anergy. Because of the high rate of INDT QFT‐G testing in this setting, individualized risk assessment is required including a thorough assessment of clinical risk factors and knowledge of local TB prevalence.