*Purpose: Tuberculosis (TB) is a common infection that affects patients after solid organ transplantation (SOT). Thus, the American Society of transplantation (AST) recommends screening all transplant candidates using either a tuberculin skin test (TST) or interferon-gamma release assay (IGRAs) for latent TB (LTBI). In immunocompromised patients, both TST and IGRA have poor sensitivity and predictive value for active TB progression. The precise frequency at which TST or IGRA-positive patients later progress to active TB after transplantation has yet to be determined. This study aims to measure IGRA and TST predictive values for the progression to active TB (pulmonary and extra-pulmonary TB) within 2 years in SOT recipients living in TB endemic regions.

*Methods: A retrospective cohort study included adult patients at the age of 14 years old or above who underwent deceased donor solid organ transplantation in Riyadh. Before transplantation, recipients were screened for LTBI using QFT, TST, or both were included and followed for two years to determine whether they had TB reactivation or progression of de novo TB infection.

*Results: A total of 183 recipients were included in this study. Within the first year after transplantation, 9 (5%) of transplant recipients were diagnosed with TB. Patients with a positive IGRA test were almost four times more likely to develop TB (RR; 3.857, 95%CI 1.090 to 12.68). IGRA had a positive predictive value of 15% and a negative predictive value of 93.3%.

*Conclusions: In conclusion, positive IGRA pre-transplantation was significantly related to the increased risk of TB development or progression regardless of INH reception. In SOT recipients living in a TB endemic area, relying on IGRA results to determine the need for prescribing INH needs to be revised.

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