Re: Interferon-gamma Release Assay Agreement With Tuberculin Skin Test in Pretransplant Screening for Latent Tuberculosis in a High-prevalence Country

Dear Editor, We read with interest the article published by Savaj and colleagues in the past issue of the Iranian Journal of Kidney Diseases. Tuberculosis (TB) is a serious public health problem. It is the second most frequent cause of death of infectious diseases worldwide with about 2 million deaths per year, and one of the most important infectious diseases in Iran. The incidence of active tuberculosis among patients on long-term dialysis is 6.9 to 52.5 times higher than in the general population. In hemodialysis patients, there is a relative compromise in acquired cell-mediated immunity, which constitutes the major determinant of host resistance for further development of disease. Tuberculosis is a serious infection affecting organ transplant recipients including kidney transplant recipients. Development of TB occurs in transplant recipients 20 to 74 times more than it does in the general population. The diagnosis and management of TB in this group is challenging, because the presenting symptoms can be atypical, and the therapy may lead to potential toxicity or interactions with immunosuppressive medications.