title: Comparison of quantiferon-TB gold with tuberculin skin test for detecting latent tuberculosis infection prior to liver transplantation.
abstract: Screening for latent tuberculosis infection (LTBI) is recommended prior to organ transplantation. The Quantiferon-TB Gold assay (QFT-G) may be more accurate than the tuberculin skin test (TST) in the detection of LTBI. We prospectively compared the results of QFT-G to TST in patients with chronic liver disease awaiting transplantation. Patients were screened for LTBI with both the QFT-G test and a TST. Concordance between test results and predictors of a discordant result were determined. Of the 153 evaluable patients, 37 (24.2%) had a positive TST and 34 (22.2%) had a positive QFT-G. Overall agreement between tests was 85.1% (kappa= 0.60, p < 0.0001). Discordant test results were seen in 12 TST positive/QFT-G negative patients and in 9 TST negative/QFT-G positive patients. Prior BCG vaccination was not associated with discordant test results. Twelve patients (7.8%), all with a negative TST, had an indeterminate result of the QFT-G and this was more likely in patients with a low lymphocyte count (p = 0.01) and a high MELD score (p = 0.001). In patients awaiting liver transplantation, both the TST and QFT-G were comparable for the diagnosis of LTBI with reasonable concordance between tests. Indeterminate QFT-G result was more likely in those with more advanced liver disease.
authors.affiliation: Transplant Infectious Diseases, and Microbiology, University of Alberta, Edmonton, Alberta, Canada. o.manuel@provlab.ab.ca
authors.forename: O
authors.initials: O
authors.lastname: Manuel
authors.forename: A
authors.initials: A
authors.lastname: Humar
authors.forename: J
authors.initials: J
authors.lastname: Preiksaitis
authors.forename: K
authors.initials: K
authors.lastname: Doucette
authors.forename: S
authors.initials: S
authors.lastname: Shokoples
authors.forename: A Y
authors.initials: AY
authors.lastname: Peleg
authors.forename: I
authors.initials: I
authors.lastname: Cobos
authors.forename: D
authors.initials: D
authors.lastname: Kumar
mesh_terms: D001500:BCG Vaccine; D005260:Female; D006046:Gold; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism*; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008107:Liver Diseases / Q000378:metabolism / Q000601:surgery; D016031:Liver Transplantation; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000378:metabolism; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000379:methods* / Q000592:standards; D014376:Tuberculosis / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D001500:BCG Vaccine; D006046:Gold; D007371:Interferon-gamma