Latent Tuberculosis Infection Amongst Allogeneic Hematopoietic Stem Cell Transplant Recipients: The Impact of Routine Pretransplant Review by a Transplant Infectious Diseases Physician.

Abstract

Identifying patients with latent tuberculosis infection (LTBI) is challenging. This is particularly true amongst immunocompromised hosts, in whom the diagnostic accuracy of available tests is limited. The authors evaluated the impact of routine pretransplant review by a transplant infectious diseases (TID) physician on LTBI screening in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients. Adult patients who received an alloHSCT between January 2018 and December 2022 were eligible for inclusion. Data were retrospectively extracted from patient records. Participants were dichotomized into those that had a routine pretransplant review with a TID physician and who that did not. Of the 116 participants included, 61.2% had a documented TID review. This intervention was associated with more frequent initiation of LTBI treatment (8.5% vs. 0.0%) and a tendency for LTBI treatment to be initiated in the absence of immunodiagnostic criteria (7.1% vs. 0.0%). A case of LTBI reactivation occurred in each group. Routine pretransplant review by TID physicians improved the recognition of risk factors for LTBI and increased the initiation of LTBI treatment in patients with a high pretest probability of LTBI. Further research is needed to evaluate the utility of routine pretransplant TID review and to determine the optimal strategy for preventing LTBI reactivation amongst alloHSCT recipients in low-endemic settings.