title: Utility of QuantiFERON-TB assay for prediction of tuberculosis development in kidney transplant patients in an intermediate-tuberculosis-burden country: lack of evidence for enhanced prediction for short-term tuberculosis development.
abstract: BACKGROUND
  Although a latent tuberculosis (TB) infection is a risk factor for active TB, the diagnosis of latent TB infection is difficult in end-stage renal disease patients.
  
  
  METHODS
  We retrospectively compared the results of the QuantiFERON-TB (QFT) test and the tuberculin skin test in patients on the waiting list for kidney transplantation (KT), and investigated whether the QFT test can predict TB development in KT recipients in an intermediate-TB-burden country.
  
  
  RESULTS
  The incidence of post-KT TB was 283 cases/100,000 patient-years among 1274 KT recipients at the Seoul National University Hospital. The overall standardized incidence ratio of TB was 4.358 compared with the general population. A past history of TB infection, smoking history, myocardial infarction after KT, and pneumocystis infection were significant predictors of subsequent TB development (adjusted odds ratios were 3.618, 2.959, 9.993, and 5.708, respectively). Among the 129 recipients who had the QFT test, 42 patients (32.5%) had positive a QFT. At a median follow-up of 8.4 ± 6.8 months, 1 patient with positive QFT results developed TB after KT, and 1 of the 87 patients with negative QFT results developed TB after KT. In both of these 2 cases, active TB developed despite isoniazid prophylaxis. Among 272 patients on the waiting list for KT, the tuberculin skin test and QFT were positive in 22.8% and 35.3%, respectively. The degree of agreement between the 2 tests was poor (κ = 0.352).
  
  
  CONCLUSIONS
  The QFT test did not predict subsequent short-term TB development. Furthermore, a long-term and larger-scale study is needed to confirm our results.
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Korea; Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: J C
authors.initials: JC
authors.lastname: Jeong
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Korea; Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: T Y
authors.initials: TY
authors.lastname: Koo
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Jeon
authors.affiliation: Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: H C
authors.initials: HC
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: J P
authors.initials: JP
authors.lastname: Lee
authors.affiliation: Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: S I
authors.initials: SI
authors.lastname: Min
authors.affiliation: Department of Internal Medicine, Eulji General Hospital, Seoul, Korea.
authors.forename: Y H
authors.initials: YH
authors.lastname: Hwang
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Korea; Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Ha
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Korea; Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: C
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Transplantation Center, Seoul National University Hospital, Seoul, Korea; Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea. Electronic address: jcyjs@dreamwiz.com.
authors.forename: J
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology