Simkins J, Kraus K, Morris M I
Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
Transpl Infect Dis. 2016 Feb;18(1):5-13. doi: 10.1111/tid.12476. Epub 2016 Jan 30.
Latent tuberculosis infection (LTBI) screening prior to solid organ transplantation is standard of care. QuantiFERON-TB Gold In-Tube (QFT-GIT) test is the preferred diagnostic test for renal transplant candidates (RTC). QFT-GIT reversions and the potential delay of living-donor kidney transplantation (LDKT) because of QFT-GIT positivity have not been examined previously in RTC.
We evaluated the prevalence of positive QFT-GIT in RTC from January 1 through December 31, 2011. In addition, we examined the demographic and renal disease data differences between QFT-GIT-positive and -negative patients, changes in QFT-GIT results, and positive QFT-GIT results reverting to negative. Lastly, we evaluated if QFT-GIT-positive patients were less likely to undergo LDKT within 6 months of QFT-GIT testing.
In total, 722 RTC were analyzed, 16% of whom had positive QFT-GIT. The QFT-GIT-positive patients were more likely to be older and foreign-born, P < 0.0001. Haitians had the highest prevalence. Of the 119 QFT-GIT-positive patients, 25% had low/intermediate-positive results and were more likely to revert to negative, compared with patients with high-positive QFT-GIT results (50% vs. 0%, P = 0.01). A trend was seen toward fewer QFT-GIT-positive patients undergoing LDKT, compared with QFT-GIT-negative patients (0% vs. 3%, P = 0.09).
Our high prevalence was likely a result of the high number of foreign-born RTC. Half of our small subset of low/intermediate-positive QFT-GIT patients reverted to negative. QFT-GIT-positive patients were more likely to have their LDKT delayed.
实体器官移植前进行潜伏性结核感染（LTBI）筛查是标准治疗方案。全血γ-干扰素释放试验（QFT-GIT）是肾移植候选者（RTC）首选的诊断检测方法。此前尚未对RTC中QFT-GIT结果的逆转情况以及因QFT-GIT阳性导致活体供肾移植（LDKT）潜在延迟的情况进行过研究。
我们评估了2011年1月1日至12月31日期间RTC中QFT-GIT阳性的患病率。此外，我们还研究了QFT-GIT阳性和阴性患者之间的人口统计学和肾脏疾病数据差异、QFT-GIT结果的变化以及QFT-GIT阳性结果转为阴性的情况。最后，我们评估了QFT-GIT阳性患者在QFT-GIT检测后6个月内接受LDKT的可能性是否较低。
总共分析了722例RTC，其中16%的患者QFT-GIT呈阳性。QFT-GIT阳性患者更可能年龄较大且出生在国外，P<0.0001。海地人的患病率最高。在119例QFT-GIT阳性患者中，25%的患者结果为低/中度阳性，与QFT-GIT结果为高阳性的患者相比，他们更有可能转为阴性（50%对0%，P=0.01）。与QFT-GIT阴性患者相比，QFT-GIT阳性患者接受LDKT的人数有减少的趋势（0%对3%，P=0.09）。
我们研究中较高的患病率可能是由于出生在国外的RTC数量较多。我们一小部分QFT-GIT低/中度阳性患者中有一半转为阴性。QFT-GIT阳性患者的LDKT更有可能延迟。
