The Impact of Systematic Latent Tuberculosis Infection Screening in Kidney Transplant Candidates: Experience From a...

UK guidance recommends targeted screening for latent tuberculosis infection (LTBI) in kidney transplant candidates based on epidemiological or clinical risk factors, whereas international guidelines favor systematic screening. We aimed to determine whether a targeted screening strategy would miss cases compared with systematic interferon-gamma release assay (IGRA) screening in a UK kidney transplant cohort.

We conducted a single-center retrospective cohort study of adult kidney transplant candidates assessed at the Royal Liverpool University Hospital between July 2021 and December 2024. LTBI prevalence was estimated among candidates with definitive IGRA results. Systematic screening was compared with a hypothetical targeted strategy restricted to high-risk candidates, using risk ratios, numbers needed to screen, and diagnostic performance measures. Multivariable logistic regression examined predictors of LTBI positivity.

Of 527 candidates assessed, 465 had definitive IGRA results, including 27 LTBI-positive and 438 LTBI-negative candidates. LTBI prevalence was 5.8% (95% CI 3.9%-8.3%). Of 96 high-risk candidates, 17 (17.7%) were LTBI-positive; targeted screening would have missed 10 cases (37.0%; 95% CI 19.4%-57.6%) in low-risk candidates and had a sensitivity of 63.0%. In multivariable analysis, LTBI positivity was associated with birth outside the UK, older age, and abnormal chest radiograph. All 22 treated candidates completed therapy with no hepatotoxicity or active TB during follow-up.

Systematic IGRA screening identified LTBI in low-risk kidney transplant candidates who would have been missed by targeted screening. These findings support consideration of routine pretransplant IGRA testing in comparable UK transplant settings, while recognizing the limitations of a single-center, low-prevalence cohort.