title: A prospective longitudinal study evaluating the usefulness of a T-cell-based assay for latent tuberculosis infection in kidney transplant recipients.
abstract: We evaluated whether ELISPOT assay can predict tuberculosis (TB) development in kidney-transplantation (KT) recipients with a negative tuberculin skin test (TST). All adult patients admitted to a KT institute between June 2008 and December 2009 were enrolled; TB development after KT was observed between June 2008 and December 2010. Isoniazid (INH) was given to those patients with positive TST or clinical risk factors for latent TB infection (LTBI). ELISPOT assay was performed on all patients, and TB development after KT was observed by a researcher blinded to the results of ELISPOT. A total of 312 KT recipients including 242 (78%) living-donor KT were enrolled. Of the 312 patients, 40 (13%) had positive TST or clinical risk factors for LTBI and received INH; none developed TB after KT. Of the remaining 272 patients, 4 (6%) of 71 with positive ELISPOT assay developed TB after KT, whereas none of the 201 patients with negative (n = 171) or indeterminate ELISPOTs (n = 30) developed TB after KT (rate difference between positive and negative/indeterminate ELISPOT, 3.3 per 100 person-years [95% CI 1.4-5.1, p<0.001]). Positive ELISPOT results predict subsequent development of TB in KT recipients in whom LTBI cannot be detected by TST or who lack clinical risk factors for LTBI.
authors.affiliation: Department of Infectious Diseases Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. kimsunghanmd@hotmail.com
authors.forename: S-H
authors.initials: SH
authors.lastname: Kim
authors.forename: S-O
authors.initials: SO
authors.lastname: Lee
authors.forename: J B
authors.initials: JB
authors.lastname: Park
authors.forename: I-A
authors.initials: IA
authors.lastname: Park
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.forename: S-C
authors.initials: SC
authors.lastname: Yun
authors.forename: J H
authors.initials: JH
authors.lastname: Jung
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
authors.forename: S C
authors.initials: SC
authors.lastname: Kim
authors.forename: S-H
authors.initials: SH
authors.lastname: Choi
authors.forename: J-Y
authors.initials: JY
authors.lastname: Jeong
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Woo
authors.forename: S-K
authors.initials: SK
authors.lastname: Park
authors.forename: J S
authors.initials: JS
authors.lastname: Park
authors.forename: D J
authors.initials: DJ
authors.lastname: Han
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013601:T-Lymphocytes / Q000276:immunology*; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid