Posttransplant screening and short-course treatment of latent tuberculosis infection in kidney transplant recipients: A prospective observational study in Taiwan

Background The incidence and treatment regimen of latent tuberculosis infection (LTBI) in patients with kidney transplant remains unclear. Methods We prospectively enrolled kidney transplant recipients (KTRs) from 2014 to 2024 for voluntary LTBI screening using QuantiFERON-TB Gold assay (QFT). The incidence and predictors for incident LTBI within 2 years were analysed among those initially without LTBI. Treatment regimens of LTBI were analysed for completion and adverse effects. Results Of 276 KTRs enrolled, 31 (11.2%) had initial positive QFT results, which were significantly associated with cirrhosis of the liver, radiographic prior TB lesion, and no use of prednisolone. At every 6-month follow-up of the QFT test for 2 years, 19 (13.6%) of the 140 remaining participants had positive conversion of LTBI status. Multivariable Cox regression showed initial QFT response (adjusted hazard ratio [aHR]: 1.09, 95% CI: 1.05-1.14, per IU/ml increment) and lymphocyte percentage (aHR 0.95, 95% CI: 0.90-0.99) to be independent factors. LTBI treatment showed no severe adverse drug effects and one interruption in the daily isoniazid regimen. Conclusion This study recruited the largest cohort to date to follow up LTBI status in patients with kidney transplant and shows its high incidence (13.6% within 2 years) even after initial negative QFT screening. Low lymphocyte percentage and high initial QFT response are significantly correlated with incident LTBI. Both the rifamycin-containing regimen and isoniazid regimen are well tolerated in KTRs. LTBI surveillance is also recommended in post-transplant status, though a validation study is required.