RT Journal Article
SR Electronic
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
FD European Respiratory Society
SP 1896
VO 38
IS Suppl 55
A1 Sester, Martina
A1 van Leth, Frank
A1 Girardi, Enrico
A1 Bruchfeld, Judith
A1 Bumbacea, Dragos
A1 Cirillo, Daniela
A1 Dilektasli, Asli G.
A1 Dominguez, José
A1 Duarte, Raquel
A1 Ernst, Martin
A1 Eyuboglu, Fusun
A1 Gerogianni, Irini
A1 Goletti, Delia
A1 Janssens, Jean Paul
A1 Julander, Inger
A1 Lange, Berit
A1 Latorre, Irene
A1 Losi, Monica
A1 Markova, Roumiana
A1 Matteelli, Alberto
A1 Migliori, Giovanni B.
A1 Milburn, Heather
A1 Ravn, Pernille
A1 Rothel, Jim
A1 Scholman, Theresia
A1 Soccal, Paola
A1 Straub, Marina
A1 Wagner, Dirk
A1 Yalcin, Aslihan
A1 Lange, Christoph
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/1896.abstract
AB 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.