Korean J Transplant.  2020 Mar;34(1):8-14. 10.4285/kjt.2020.34.1.8.

Comparative evaluation of QuantiFERON-TB Gold Plus for diagnosis of latent tuberculosis infection during solid organ transplantation

• Yoon SJ
• Kwon WK
• Jeong MJ
• Lee J
• Oh HY
• Huh W
• Jang HR
• Joh JW
• Kim JM
• Choi GS
• Kim SJ
• Park JB
• Lee KW
• Sinn DH
• Choi JO
• Kang ES

• KMID: 2503777
• DOI: http://doi.org/10.4285/kjt.2020.34.1.8

Abstract

Background
The diagnosis of latent tuberculosis infection (LTBI) in solid organ transplantation (SOT) patients under lifelong immunosuppression has profound effects on preoperative and postoperative management. Interferon-gamma release assay (IGRA) is widely used to screen LTBI before or after transplantation.
Methods
We evaluated the effect of posttransplantation immunosuppression on IGRA and influencing factors by measuring interval change of QuantiFERON-TB Gold Plus (QFT-Plus) between pretransplantation (pre-QFT-Plus) and posttransplantation (post-QFT-Plus) state in 20 patients who previously had reactive IGRA but not taken LTBI treatment.
Results
Eleven (55%) out of 20 pre-QFT-Plus reactive patients became nonreactive state in repeated QFT-Plus (post-QFT-Plus) at 194–413 days (median, 257 days) after transplantation (discordant group). Even in persistently reactive group (concordant group), interferon-gamma (IFN-γ) levels after transplantation were decreased about 34% and 36% of their pretransplantation levels for TB1 and TB2, respectively. The only significant factors that affect interval change of QFT-Plus between pre- and post-SOT status were the concentrations of IFN-γ in pre-QFT-Plus (6.93 vs. 0.44 IU/mL in TB1 and 7.33 vs. 0.71 IU/mL in TB2).
Conclusions
The reactivity of QFT-Plus is significantly compromised by immunosuppressive therapy, which increase the risk of false negative, particularly in patients with low level of IGRA reactivity. Therefore, interpretation of IGRA under immunosuppressive treatment require a caution and eventually, more sensitive tuberculosis-specific cytokine markers might be needed.

Keyword

Organ transplantation; Interferon-gamma releasing assay; Immunosuppression

Figure

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  Fig. 1 Distribution of interferon-gamma (IFN-γ) values of pre- and posttransplantation QuantiFERON-TB Gold Plus (QFT-Plus) in concordant (A) and discordant (B) patient groups. Each line presents the changes of IFN-γ between pre-QFT-Plus and post-QFT-Plus in each patient. TB, tuberculosis; Pre-TB1 minus NIL, TB1 antigen tube minus Nil IFN-γ concentration before SOT; Post-TB1 minus NIL, TB1 antigen tube minus Nil IFN-γ concentration after SOT; Pre-TB2 minus NIL, TB2 antigen tube minus Nil IFN-γ concentration before SOT; Post-TB2 minus NIL, TB2 antigen tube minus Nil IFN-γ concentration before SOT.

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