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Lymphocyte Subset Affects the Latent Tuberculosis Infection Diagnosis by QuantiFERON TB Gold Plus in Renal Transplantation
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A5548 - Lymphocyte Subset Affects the Latent Tuberculosis Infection Diagnosis by QuantiFERON TB Gold Plus in Renal Transplantation
Author Block: H. Igari1, S. Ishikawa2, M. Tsuyuzaki3, K. Suzuki3, N. Akutsu4, K. Saigo4; 1Division of Infection Control, Chiba University Hospital, Chiba, Japan, 2Department of Respiratory Medicine, National Hospital Organization Chiba-East Hospital, Chiba, Japan, 3Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan, 4Department of Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan.
[Rationale] Interferon gamma release assays (IGRAs) are useful tools for the diagnosis of latent Tuberculosis infection (LTBI). The patients of renal transplantation receiving immune suppressive agents are at increased risk of developing active Tuberculosis (TB). QuantiFERON-TB Gold Plus (QFT-Plus) is 4th generation QFT, and two Tubes are used for TB specific antigen stimulation. Then QFT-Plus can estimate the CD8 T-cell immune response elicited by TB specific antigen, in addition to CD4 T-cell. This mechanism would provide the information associated with immune response to TB specific antigen in the patients of renal transplantation. [Method] Total 113 renal transplantation patients were enrolled. The median age was 49 yr. (IQR 44-63). QFT-Plus was conducted in accordance with manufacture's manuals. The cut-off for positive in QFT-Plus was 0.35 IU/mL. Lymphocyte subsets in peripheral venous blood were analyzed. The percentage of CD4 T-cell or CD8 T-cell was determined by flow cytometry. [Results] The number of QFT-Plus positive was 6 (5.3%). Tube-1(for CD4 response) positive was six patients, Tube-2 (for CD4 and CD8) positive was five patients. There were no patients with indeterminate. The counts of CD4 T-cell and CD8 T-cell (median (IQR)) were 684 (497-915) and 485 (352-683), respectively. The ratio of CD4/CD8 (IQR) was 1.35 (0.97-1.94). The optimal cut-off for CD4 T-cell, CD8 T-cell and the CD4/CD8 were 775/μL, 600/μL and 1.0, respectively. The patients with CD8 T-cell >=600/μL had significantly higher positive rate. The patients with the CD4/CD8 ratio of less than 1.0 also had significantly higher positive rates. The patients with CD4 T-cell >=775/μL did not show significant differences in positive rate. The count of CD8 T-cell revealed the positive correlation with the interferon-γ production in Tube-1 and Tube-2, however, the counts of CD4 did not. [Conclusion] QFT-Plus positive rate of 5.3% is acceptable in consideration of Japanese TB statistics. Our result demonstrated the CD8 T-cell dominant immune response to TB specific antigen in the patients of renal transplantation.
Author Block: H. Igari1, S. Ishikawa2, M. Tsuyuzaki3, K. Suzuki3, N. Akutsu4, K. Saigo4; 1Division of Infection Control, Chiba University Hospital, Chiba, Japan, 2Department of Respiratory Medicine, National Hospital Organization Chiba-East Hospital, Chiba, Japan, 3Chiba Foundation for Health Promotion and Disease Prevention, Chiba, Japan, 4Department of Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan.
[Rationale] Interferon gamma release assays (IGRAs) are useful tools for the diagnosis of latent Tuberculosis infection (LTBI). The patients of renal transplantation receiving immune suppressive agents are at increased risk of developing active Tuberculosis (TB). QuantiFERON-TB Gold Plus (QFT-Plus) is 4th generation QFT, and two Tubes are used for TB specific antigen stimulation. Then QFT-Plus can estimate the CD8 T-cell immune response elicited by TB specific antigen, in addition to CD4 T-cell. This mechanism would provide the information associated with immune response to TB specific antigen in the patients of renal transplantation. [Method] Total 113 renal transplantation patients were enrolled. The median age was 49 yr. (IQR 44-63). QFT-Plus was conducted in accordance with manufacture's manuals. The cut-off for positive in QFT-Plus was 0.35 IU/mL. Lymphocyte subsets in peripheral venous blood were analyzed. The percentage of CD4 T-cell or CD8 T-cell was determined by flow cytometry. [Results] The number of QFT-Plus positive was 6 (5.3%). Tube-1(for CD4 response) positive was six patients, Tube-2 (for CD4 and CD8) positive was five patients. There were no patients with indeterminate. The counts of CD4 T-cell and CD8 T-cell (median (IQR)) were 684 (497-915) and 485 (352-683), respectively. The ratio of CD4/CD8 (IQR) was 1.35 (0.97-1.94). The optimal cut-off for CD4 T-cell, CD8 T-cell and the CD4/CD8 were 775/μL, 600/μL and 1.0, respectively. The patients with CD8 T-cell >=600/μL had significantly higher positive rate. The patients with the CD4/CD8 ratio of less than 1.0 also had significantly higher positive rates. The patients with CD4 T-cell >=775/μL did not show significant differences in positive rate. The count of CD8 T-cell revealed the positive correlation with the interferon-γ production in Tube-1 and Tube-2, however, the counts of CD4 did not. [Conclusion] QFT-Plus positive rate of 5.3% is acceptable in consideration of Japanese TB statistics. Our result demonstrated the CD8 T-cell dominant immune response to TB specific antigen in the patients of renal transplantation.
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