Johns Hopkins Comprehensive Transplant Center, Baltimore, Maryland, USA.
Curr Opin Organ Transplant. 2008 Aug;13(4):400-4. doi: 10.1097/MOT.0b013e3283094ba3.
Recently, four organ recipients were infected with HIV through transplantation, raising questions about current serologic testing policies. Currently, the decision to use enzyme-linked immunosorbent assay or nucleic acid testing, an expensive and time-consuming method capable of detecting more recent infections, is left up to individual organ procurement organizations. The purpose of this review was to present estimates of the window period between infection and detection by enzyme-linked immunosorbent assay and nucleic acid testing for HIV, hepatitis B virus, and hepatitis C virus; and to evaluate the impact of those infections on posttransplant outcomes.
Nucleic acid testing for HIV can detect infections 12-13 days earlier than enzyme-linked immunosorbent assay; in the case of hepatitis B virus, infections are detected 21.8-36 days earlier; and in the case of hepatitis C virus, infections are detected 26-60 days earlier. Studies indicate that it is possible to manage all three infections posttransplant. HIV/hepatitis C virus coinfections seem to present the greatest posttransplant management challenges due to drug toxicities.
Nucleic acid testing can reduce the window period and thus increase the probability of detecting viral infections. HIV, hepatitis B virus, and hepatitis C virus positive organs may be appropriate for use in some situations; nucleic acid testing helps patients and physicians make informed decisions about their use.
最近，有四名器官接受者在移植过程中感染了 HIV，这引发了对当前血清学检测政策的质疑。目前，是否使用酶联免疫吸附测定或核酸检测（一种昂贵且耗时的方法，能够检测到更近的感染）的决定取决于各个器官采购组织。本文旨在介绍 HIV、乙型肝炎病毒和丙型肝炎病毒的酶联免疫吸附测定和核酸检测的感染窗口期估计；并评估这些感染对移植后结局的影响。
核酸检测可比酶联免疫吸附测定提前 12-13 天检测到 HIV 感染；对于乙型肝炎病毒，可提前 21.8-36 天检测到感染；对于丙型肝炎病毒，可提前 26-60 天检测到感染。研究表明，在移植后可以对所有三种感染进行管理。由于药物毒性，HIV/丙型肝炎病毒合并感染在移植后管理方面似乎带来了最大的挑战。
核酸检测可以缩短窗口期，从而提高检测病毒感染的概率。HIV、乙型肝炎病毒和丙型肝炎病毒阳性器官在某些情况下可能适合使用；核酸检测有助于患者和医生就其使用做出明智的决策。
