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.