F- 08: Infectious complications
The Diagnostic Accuracy of Tests for Latent Tuberculosis Infection in
Hemodialysis Patients: A Systematic Review and Meta-Analysis
Ferguson, Thomas W.1,2; Tangri, Navdeep1,2,3; Macdonald, Kerry2,4; Hiebert, Brett1; Rigatto,
Claudio2,3; Sood, Manish M.5; Shaw, Souradet1; Lerner, Blake2; Xu, Yang2; Mahmud, Salaheddin1;
Komenda, Paul2,3
Author Information
1
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
2
Seven Oaks General Hospital Renal Program, Winnipeg, Canada.
3
Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada.
4
Department of Library Services, University of Manitoba, Winnipeg, Canada.
5
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Journal : Transplantation
Year : 2015 / Month : May
Volume 99 :
Pages : 1084–1091
doi: 10.1097/TP.0000000000000451
ABSTRACT
Background
Reactivation of latent Mycobacterium tuberculosis infection is an important health concern for
patients on hemodialysis because of their immunosuppressed state and in kidney transplant patients
receiving immunosuppressive therapy to prevent organ rejection. There are several tests available
to determine the presence of latent tuberculosis infection: the tuberculin skin test (TST),
QuantiFERON-TB Gold (QFT-G), and T-SPOT.TB. The objective of this study is to evaluate the
diagnostic accuracy of these tests in determining latent tuberculosis infection in the hemodialysis
population.
Methods
The study design was a systematic review. We selected studies with adequate information to
ascertain test sensitivity or specificity of the TST, QFT-G, and TSPOT.TB with regards to
determining latent tuberculosis infection in the hemodialysis population.
Results
One hundred two articles were selected for full review, and 17 were included in the meta-analysis.
The TST had a pooled sensitivity of 31% (26%–36%, 95% confidence interval) and specificity of
63% (60%–65%) across eight studies. The QFT-G test had a pooled sensitivity of 53% (46%–59%)
and specificity of 69% (65%–72%) across nine studies. The T-SPOT.TB test had a pooled sensitivity
of 50% (42%–59%) and specificity of 67% (61%–73%) across three studies.
Conclusion
The QFT-G and the T-SPOT.TB tests were more sensitive than the TST for diagnosis of latent
tuberculosis infection in patients on hemodialysis while offering a comparable level of specificity.
This systematic review calls into question the practice of using the TST to screen in this population,
especially in patients considered for kidney transplantation.
COMMENTS
Infection with Mycobacterium tuberculosis afflicts millions of individuals worldwide . Primary infection
in immunocompetent individuals sometimes results in containment but not eradication of the
tuberculosis organism, which can remain dormant in the host for many decades. Latent tuberculosis
infection is the name of this state of dormant infection, often defined as an asymptomatic state with
the presence of tuberculosis organisms in lung tissues without any clinical or radiologic symptoms of
an active disease. The importance of accurately diagnosing latent tuberculosis lies in the potential
for reactivation to active and transmissible disease when the host is immunosuppressed by
comorbid illness or medical therapy.
Reactivation is of particular relevance to patients with kidney failure receiving dialysis or
transplantation.
There are several diagnostic tests available to determine the presence of latent tuberculosis
infection: the tuberculin skin test (TST) or the interferon-γ release assays: QuantiFERON-TB Gold
(QFT-G) and ELISPOT (T-SPOT.TB).
Clinical standards to establish the diagnosis of tuberculosis include recent contact with someone
who has been infected with tuberculosis, history of active disease, or a chest x-ray indicative of
infection. Some studies also use a combination of these factors; however, there is no definitive
agreement across the literature on the gold standard applicable in clinical practice. Consequently,
the authors conducted a systematic review of studies evaluating the diagnostic accuracy of the TST,
QFT-G, and T-SPOT.TB in this population.
They found that the QFT-G or T-SPOT tests were more sensitive than using the TST across a
variety of possible diagnostic standards while offering a comparable measure of specificity.
Pr. Jacques CHANARD
Professor of Nephrology