TY - JOUR T1 - Head-to-head analysis of IGRAs and skin-testing in immunocompromised patients: Interim analysis of a multicenter TBNET study JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - 1896 AU - Martina Sester AU - Frank van Leth AU - Enrico Girardi AU - Judith Bruchfeld AU - Dragos Bumbacea AU - Daniela Cirillo AU - Asli G. Dilektasli AU - José Dominguez AU - Raquel Duarte AU - Martin Ernst AU - Fusun Eyuboglu AU - Irini Gerogianni AU - Delia Goletti AU - Jean Paul Janssens AU - Inger Julander AU - Berit Lange AU - Irene Latorre AU - Monica Losi AU - Roumiana Markova AU - Alberto Matteelli AU - Giovanni B. Migliori AU - Heather Milburn AU - Pernille Ravn AU - Jim Rothel AU - Theresia Scholman AU - Paola Soccal AU - Marina Straub AU - Dirk Wagner AU - Aslihan Yalcin AU - Christoph Lange Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/1896.abstract N2 - The superior sensitivity of IFNγ release assays (IGRAs) in diagnosing LTBI above tuberculin skin testing (TST) may be compromised by immunodeficiency. We performed direct comparisons between tests in immunocompromised patients.IGRAs (T-SPOT/QFT) and TST were performed and clinical data on drugs and TB exposure were collected. Interim results from 193 organ transplant patients and 204 patients with rheumatoid arthritis (RA) are presented.In transplant patients, 80% had results for all 3 tests, which were less often positive for TST (11.7%) than for T-SPOT (20.8%) and QFT (15.6%, p=0.018). Agreement was substantial between IGRAs (κ=0.61), and only fair between IGRAs and TST (κ=0.22, T-SPOT; 0.34, QFT). All 3 tests were more often negative despite TB risk factors in patients <1 year post transplant as compared to patients ≥1 year. In RA patients, 91% had result for all 3 tests, which were positive in 36.0% (TST), 26.3% (T-SPOT), and 24.2% (QFT, p=0.002). Agreement was only fair between IGRAs and TST (κ=0.29, T-SPOT; 0.33, QFT) and substantial between IGRAs (κ=0.77). Negativity rate despite TB risk factors was high in all tests, particularly when receiving >3 immunomodulatory drugs. All tests in both groups were associated with TB-exposure without marked confounding by age, sex, number of drugs or time post transplant.Despite TB risk factors, results are more often negative in transplant patients in the first year post transplant and in RA patients with >3 immunomodulatory drugs, likely due to higher level of immunosuppression. This emphasises the need for LTBI screening prior to transplantation or immunosuppressive treatment to increase diagnostic accuracy. ER -