Introduction: Diagnosing and treating tuberculosis after kidney transplantation is challenging, and mortality is high. In an epidemiological study performed at our Center, there was an increase in tuberculosis incidence in the last decade. Patients that received latent tuberculosis (LT) treatment with isoniazid had a lower incidence of active infection after transplantation. One concern was that the standard evaluation for LT before kidney transplantation was falling to detect patients, contributing to active infection cases under immunosuppresion. Objective: to present the results of interferon-gama release assays as an additional tool in the diagnosis of LT infection prior to kidney transplantation (KT), both in recipients and living donors. Results: from April, 2014 to Nov, 2017 we performed 798 adult KT, and collected 351 samples of the test (297 recipients and 54 living donors). Using our standard evaluation, 40 (5%) patients would receive LT treatment: 16 for previous tuberculosis, 11 for positive TT, 7 for radiological abnormalities, 5 for donors' positive TT, one for donor's hepatic granuloma. Using Igra, we recommended treatment for 95 (11.9 %) patients: 77 positive recipients' tests and 13 positive donors' tests and 5 positive donor's and recipient's tests. Associating standard evaluation and Igra results, 107 (13.4%) patients were referred to LT treatment (28 were referred for both indications). Twenty-two (20.5%) patients failed to receive isoniazid: 3 died shortly after transplantation, one transferred to another center, 4 developed active tuberculosis before initiating treatment (in the first month after KT); the remaining 14 had clinical complications or a medical contra-indication for isoniazid therapy. There were 13 (1.6%) cases of tuberculosis during the study period. Five of the 13 had positive Igra: 4 did not start isoniazid due to active disease early after KT and one had a diagnosis of arthritic tuberculosis during isoniazid treatment. One of the 13 received isoniazid treatment for 6 months due to donor's positive Igra and developed disseminated tuberculosis 18 months after the end of treatment. The remaining 7 did not have LT evidence. Amongst the 13 patients with tuberculosis, 3 (23%) died, 3 (23%) experienced graft loss and 7 (53.8%) were cured. Conclusion: incorporating Igra as a diagnostic tool to detect LT before KT increases isoniazid treatment recommendation to avoid active tuberculosis cases.

CITATION INFORMATION: Garcia V., Meinerz G., da Silva C., Keitel E. Latent Tuberculosis Diagnosis Prior to Kidney Transplantation in a High Burden Country: Improvement with Serological Tests Am J Transplant. 2017;17 (suppl 3).

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