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Selected Publication:
Rosenstock, P.
Screening and therapy for latent tuberculosis (LTB) before liver, kidney and heart transplantation at the LKH Graz between 2007 and 2012
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2021. pp. 39
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- Authors Med Uni Graz:
- Advisor:
- Flick Holger
- Kniepeiss Daniela
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- Abstract:
- Introduction/Background: Recommendations for screening and therapy for latent tuberculosis (asymptomatic, non-active infection) in immunosuppressed patients exist, but they are mostly based on data from high prevalence countries. In Austria there is no general approach yet for managing latent tuberculosis in transplant candidates. Handling of those patients is a matter of experience and judgement. Therefore, we took part in a larger study performed by TBnet. The aim was to retrospectively collect data on latent tuberculosis prevalence in transplant recipients, their respective outcome and confounders. The incidence of active tuberculosis (symptomatic infection) among transplant recipients is stated to be 20- to 74-fold times higher than the general population. This is in consistence with the consensus statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA) from 2009, in which they estimated an incidence of active tuberculosis among solid organ recipients of 512 cases per 100,000 inhabitants per year. Because active tuberculosis after transplantation is usually based on pre-existing latent tuberculosis, gathering of data about latent tuberculosis prevalence in transplant candidates is highly important. Materials and Methods: This was an explorative study. Data were collected retrospectively about transplant patients, their comorbidities and latent tuberculosis incidence, preventive treatment and outcome. We used a questionnaire, provided by TBnet, to collect data from the Styrian electronic communication and information- network MEDOCS, which is used by all hospitals of the Styrian hospital network KAGES. The aim was to include all patients who were transplanted at the Medical University Graz between 2007 and 2012. There were no factors, which excluded patients from this study. In this diploma thesis clinical data from all KAGES associated hospitals was evaluated. Results: In total, there were 261 renal, 11 renal/pancreas, 90 liver and 27 heart transplantations. Latent tuberculosis screening tests were performed in 15.5% (n=58) of all patients. Most frequently (n=59) interferon-gamma-release-assays were used, either alone (n=57) or in combination with tuberculin skin test (n=2). A single time (n=1) tuberculin skin test alone was used. Out of the 58 screened patients only 3 had a positive test result and received a chemoprevention with isoniazid. None of the 375 transplanted patients developed active tuberculosis after transplantation. We lost follow-up only of 23 patients. Discussion: There is a lack of dependable data for latent tuberculosis in transplant recipients in countries with low tuberculosis incidence. In this study, which only evaluated data from patients who were transplanted at the Medical university of Graz, we found that even with a presumed higher tuberculosis risk in solid organ recipients, none of our patients developed active tuberculosis after transplantation. This further raises the question how to handle screening and preventive treatment in transplant candidates in countries with a low tuberculosis prevalence like in Austria.