Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
J Infect Chemother. 2013 Oct;19(5):1009-13. doi: 10.1007/s10156-013-0578-9. Epub 2013 Aug 7.
There are few data on donor screening for latent tuberculosis infection (LTBI) using the tuberculin skin test (TST) and interferon-gamma releasing assay (IGRA). In South Korea, most renal allografts involve living donors (average, 80%). Hence, we have an opportunity to evaluate donor and recipient screening for LTBI by TST and IGRA. All donors and recipients admitted for kidney transplantation during a 20-month period were evaluated prospectively by using TST and Mycobacterium tuberculosis-specific enzyme-linked immunosorbent spot (ELISPOT) assay. The study population consisted of 205 living donor-recipient pairs (≥16 years) including 15 (7%) who yielded indeterminate donor or recipient ELISPOT results. Of the 205 donors, 63 (31%) gave a positive TST ≥5 mm, 33 (16%) a positive TST ≥10 mm, and 96 (47%) a positive ELISPOT. Of the 205 recipients, 9 (5%) gave a positive TST ≥5 mm, 3 (2%) a positive TST ≥10 mm, and 79 (39%) had a positive ELISPOT. Of the 205 donor-recipient pairs, only 59 (29%) gave negative donor and recipient ELISPOT results and 139 (68%) negative donor and recipient TSTs (<5 mm) (P < 0.001). One third of donor-recipient pairs tends to be positive in the TST, and two thirds of the donor-recipient pairs tends to be positive in the ELISPOT. Given the high positive rate of LTBI obtained by screening donors, further studies on the clinical value of solid organ transplant donors with positive TST or ELISPOT and health economics analysis in countries with intermediate burden of TB are needed for policy decisions on isoniazid (INH) prophylaxis.
关于使用结核菌素皮肤试验（TST）和干扰素 - γ释放测定（IGRA）对潜伏性结核感染（LTBI）进行供者筛查，数据较少。在韩国，大多数肾移植供体为活体供体（平均为 80％）。因此，我们有机会通过 TST 和 IGRA 评估供者和受者的 LTBI 筛查。在 20 个月的时间内，所有接受肾移植的供者和受者均前瞻性接受 TST 和结核分枝杆菌特异性酶联免疫斑点（ELISPOT）检测。研究人群包括 205 对接受肾移植的活体供者-受者（≥16 岁），其中 15 对（7％）ELISPOT 结果不确定。在 205 名供者中，63 名（31％）TST 阳性≥5mm，33 名（16％）TST 阳性≥10mm，96 名（47％）ELISPOT 阳性。在 205 名受者中，9 名（5％）TST 阳性≥5mm，3 名（2％）TST 阳性≥10mm，79 名（39％）ELISPOT 阳性。在 205 对供者-受者中，只有 59 对（29％）供者和受者的 ELISPOT 结果均为阴性，139 对（68％）供者和受者的 TST 均为阴性（<5mm）（P<0.001）。三分之一的供者-受者对 TST 呈阳性，三分之二的供者-受者对 ELISPOT 呈阳性。鉴于通过筛查供者获得的 LTBI 阳性率较高，对于具有阳性 TST 或 ELISPOT 的实体器官移植供者的临床价值以及在结核病负担中等的国家进行卫生经济学分析，需要进一步研究，以便为异烟肼（INH）预防做出政策决策。
