Prevalence of Latent Tuberculosis Infection in Transplant Candidates: A Systematic Review and Meta-Analysis Publisher Pubmed



Rahimifard N¹ ; Mahmoudi S² ; Mamishi S^{2, 3} ; Pourakbari B²
Source: Microbial Pathogenesis Published:2018

Abstract

Introduction: Tuberculosis (TB) is considered as a serious complication for organ transplant recipients; therefore, the detection and appropriate treatment of latent infection are recommended for preventing active TB infections in the future. The objective of this review is to conduct a systematic review and meta-analysis of studies assessing the prevalence of latent TB infection (LTBI) in transplant candidates. Methods: Electronic databases, including MEDLINE (via PubMed), SCOPUS were searched until 30 June 2017. The prevalence of LTBI was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 14. Results: The pooled prevalence of LTBI based on tuberculin skin test (TST) in different transplant types was as follows: liver 24% (14%–33%, 95% CI), lung 22% (18%–26%), renal 21% (16%–27%, 95% CI) and hematopoietic stem cell transplantation (HCT) 14% (9%–19%). The prevalence of LTBI based on Interferon Gamma Release Assay (IGRA) tests in renal transplant candidates was 31% (95% CI; 25–37%), which was much higher than the prevalence of LTBI in liver transplant candidates (25%, 95% CI; 17–33%) and HCT transplant candidates (13%, 95% CI; 10–16%) and there was statistically significant differences between them. The pooled prevalence of indeterminate results based on IGRAs test in different transplant types was as follows: renal 6% (4%–8%, 95% CI) and liver 12% (2%–21%, 95% CI). Subgroup analysis revealed that there were statistically significant differences between the overall prevalence of indeterminate results by using IGRA tests in liver transplant candidates (12%, 95% CI; 2–21%) and renal transplant candidates (6%, 95% CI; 4–8%). The pooled prevalence of post-transplant TB was 2% (1%–2%, 95% CI) and its occurrence was more common in renal recipients (4% (2%–7%, 95% CI)) than in the liver transplant patients (1% (0%–2%, 95% CI)). The prevalence of LTBI in the subgroup (i.e. the patients' mean age was <50 years) was significantly higher than the prevalence of LTBI by using TST/IGRAs in the other subgroup (i.e. the patients’ mean age was ≥50 years). Conclusion: Our study suggests fair overall agreement between IGRAs and TST in patients requiring liver and HCT transplantation, while a superiority of IGRAs over TST in patients requiring renal transplantation was seen. © 2018 Elsevier Ltd