1391. Latent Tuberculosis Screening Cascade in Liver Transplant Candidates: A Single, Transplant Center Experience

Abstract

BackgroundScreening for latent tuberculosis infection (LTBI) is an essential component of the pre-transplant evaluation and key in identifying patients at risk for TB reactivation post-transplantation. At our center, liver transplant candidates (LTC) are routinely referred to transplant infectious disease (TID) for pre-TID evaluation including LTBI screening. Our aim was to determine the effectiveness of our screening practices and identify barriers to LTBI treatment.MethodsWe conducted a medical chart review of actively wait-listed LTC as of February 18/2019. Data points collected included: TB risk factors, TID referral and completion of evaluation, intention to screen for LTBI (defined as placing an order), screening completion (with documentation of a test result), screening method (IGRA or PPD), screening test result, radiographic findings, and treatment initiation and completion, if applicable. A positive screen was defined as a positive IGRA or PPD result while a negative screen was defined as a negative result or an indeterminate result with lack of epidemiological risk factors and negative radiographic findings. The proportion of LTC who completed each step in the cascade of care for LTBI was determined.ResultsOf 102 LTC, 100 met inclusion criteria. Two were excluded due to past LTBI treatment. Of 100 LTC, 95 completed a pre-TID evaluation. For 94 (98.9%), there was intention to screen. Of those intended for screening, 91 (95.8%) successfully completed screening; 6 (6.6%) patients screened positive and 85 (93.4%) screened negative. All 6 LTC who tested positive were recommended for treatment. Five of 6 (83.3%) agreed to treatment, 3/6 (50.0%) started treatment, and all 3 completed treatment. Reasons for non-treatment included: deferral until completion of HCV treatment or hepatologist approval or patient refusal. Treatment regimens included rifampin (n = 1) and isoniazid (n = 2).ConclusionThe prevalence of LTBI in our LTC cohort was low. Nonetheless, TID played a role in the successful completion of LTBI screening and identifying those appropriate for treatment in this vulnerable patient population. Barriers to successful LTBI screening and treatment completion are contingent on effective care coordination and addressing competing co-morbidities. Disclosures All authors: No reported disclosures.