790. The efficacy of the interferon-gamma releasing assay-based isoniazid treatment for preventing active tuberculosis in kidney transplant recipients: a quasi-experimental study
Session: Poster Abstract Session: Tuberculosis and Other Mycobacterial Infections
Thursday, October 4, 2018
Room: S Poster Hall

Background: Interferon-¥ã releasing assays (IGRAs) are useful for diagnosing LTBI. However, there are limited data on the efficacy of IGRA-based isoniazid (INH) treatment with/without back-up tuberculin skin test (TST) to prevent the development of TB in solid organ transplant recipients.

Methods: All adults patients admitted to a KT unit from January 2014 to December 2016 were retrospectively reviewed in a 2700 bed, tertiary-care hospital in Seoul, South Korea. The IGRA (i.e., QuantiFERON-In-Tube) with/without TST was performed on all recipients before KT, and 9-month INH treatment was given to patients with clinical risk factors for LTBI regardless of IGRA results. Our hospital policy on LTBI diagnosis and treatment was changed as follows. Period 1 (January 2014 ~ September 2015) adopted IGRA-based INH treatment. We administered INH treatment to all patients with positive IGRA results. Period 2 and period 3 adopted IGRA-based followed by back-up TST-based INH treatment. Period 2 (October 2015 ~ December 2015) included the temporary shortage of Mantoux test, so INH treatment was not given to the patients with positive IGRA since back-up TST was not performed. In period 3 (January 2016 ~ December 2016), we administered INH treatment to the patients with positive IGRA results followed by back-up TST¡Ã10 mm. The development of TB after KT as the primary endpoint was observed from January 2014 to April 2018.

Results: The study flow is shown in Figure 1. Of the 1150 KT recipients, 14 (1.2%) developed TB (incidence rate 0.63 per 100 person-years, 95% CI 0.35-1.06). The median time for TB development was 9.4 months (IQR 4.7-14.5). Seven (3.2%) of 216 patients with positive IGRA without INH treatment developed TB, whereas none of 106 patients with positive IGRA with INH treatment developed TB (rate difference 2.43 per 100 person-years, P=0.008) and 7 (0.8%) of 828 patients with negative or indeterminate IGRA results developed TB (rate difference 2.0 per 100 person-years, P<0.001). The number needed to treat (NNT) for IGRA-based INH treatment was 31 (95% CI 18-114).

Conclusion: IGRA-based INH treatment is effective to prevent the development of TB in KT recipients without clinical risk factors for LTBI with reasonable NNT.

 


Hae-In Kim, MD1, Kyeong Min Jo, M.D1, Sungim Choi, M.D1, Kyung Hwa Jung, MD2, Jung Wan Park, MD3, Ji Hyun Yun, MD4, Min Jae Kim, MD1, Yong Pil Chong, MD, PhD1, Sang-Oh Lee, MD, PhD1, Sang-Ho Choi, MD, PhD1, Yang Soo Kim, MD, PhD1, Jun Hee Woo, MD, PhD1, Sung Shin, MD5, Young-Hoon Kim, MD5, Duck Jong Han, MD, PhD5 and Sung-Han Kim, MD, PhD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), (2)Departments of Infectious Diseases, Departments of Infectious, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), (3)Department of Infectious Disease, Asan medical center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), (4)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea, Republic of (South), (5)Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South)

Disclosures:

H. I. Kim, None

K. M. Jo, None

S. Choi, None

K. H. Jung, None

J. W. Park, None

J. H. Yun, None

M. J. Kim, None

Y. P. Chong, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

S. Shin, None

Y. H. Kim, None

D. J. Han, None

S. H. Kim, None

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