Chest Computed Tomography Is More Likely to Show Latent Tuberculosis Foci Than Simple Chest Radiography in Liver Transplant Candidates

Although the detection and treatment of latent tuberculosis infections (LTBIs) in transplant candidates are essential, current diagnostic methods for LTBIs are limited, especially in immunocompromised subjects. Pretransplant chest computed tomography (CT) may reveal more LTBI foci and thus predict the development of posttransplant tuberculosis (TB) more efficiently; however, this hypothesis has not yet been investigated. Thirty-six liver transplantation (LT) recipients who developed TB (the TB group) and 144 LT recipients who did not develop TB (the control group) were retrospectively enrolled into a study with a nested case-control design, and their clinical characteristics and radiological findings were compared. Tuberculin skin tests (TSTs) were not performed, and none of these patients had been treated for LTBIs. Thirty-six of 2549 LT recipients (1.4%) were diagnosed with TB after LT (median = 10 months, range = 1-80 months). Twenty-eight patients (77.8%) successfully completed the treatment. There were no significant differences in the clinical characteristics of the 2 groups. Abnormal CT findings (40.0% versus 17.3%, P = 0.018) and chest X-ray (CXR) findings (25.0% versus 11.8%, P = 0.044) suggestive of healed TB were significantly more frequent in the TB group versus the control group. Of the 10 patients who underwent chest CT and developed TB, 5 (50%) showed abnormal findings only on chest CT scans, whereas their CXR results were normal. In conclusion, a pretransplant chest CT scan is more likely to show an LTBI than a CXR in those with post-LT TB. The usefulness of chest CT along with traditional methods such as TSTs for LTBI screening should be further investigated. Liver Transpl 17:963-968, 2011. (C) 2011 AASLD.