Roth P J, Grim S A, Gallitano S, Adams W, Clark N M, Layden J E
Department of Medicine, Greenville Health System, Greenville, South Carolina, USA.
Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
Transpl Infect Dis. 2016 Feb;18(1):14-21. doi: 10.1111/tid.12489. Epub 2016 Feb 3.
Accurately identifying latent tuberculosis (TB) infection (LTBI) in liver and renal transplant candidates is important because of the risks associated with both treatment of LTBI and reactivation of disease in this population. Many programs advocate yearly screening of patients awaiting organ transplantation. The reproducibility of serial interferon-gamma release assay (IGRA) testing in transplant candidates has not been studied.
We conducted a retrospective longitudinal study of patients listed for liver or kidney transplantation between January 1, 2005 and February 1, 2012 at the University of Illinois Medical Center at Chicago. Data collected included demographics, transplant type, IGRA results, treatment received, and mortality.
The study population was comprised of 795 adults; 79 (10%) had at least 1 indeterminate result; indeterminate results were less common in men (P = 0.01) and more common in liver transplant candidates (P < 0.001). The reversion frequency was 27% with a rate of 158.1 reversions in 1000 person-years. A higher magnitude of initial TB response values was predictive of consistently positive results (P < 0.001). The conversion frequency was 15% with a rate of 82.6 conversions in 1000 person-years. Among those who converted, the values of the IGRA varied, with 48% having a TB response of <1 IU/mL, 41% 1-5 IU/mL, and only 10% >5 IU/mL.
A significant number of conversions and reversions occur during serial IGRA testing of transplant candidates. Delineating true-positive converters from false-positives is an issue that warrants further study.
准确识别肝移植和肾移植候选受者中的潜伏性结核感染（LTBI）非常重要，因为该人群中LTBI治疗及疾病复发均存在风险。许多项目提倡对等待器官移植的患者进行年度筛查。尚未对移植候选受者中连续干扰素-γ释放试验（IGRA）检测的可重复性进行研究。
我们对2005年1月1日至2012年2月1日期间在芝加哥伊利诺伊大学医学中心登记等待肝移植或肾移植的患者进行了一项回顾性纵向研究。收集的数据包括人口统计学信息、移植类型、IGRA结果、接受的治疗及死亡率。
研究人群包括795名成年人；79名（10%）至少有1次不确定结果；不确定结果在男性中较少见（P = 0.01），在肝移植候选受者中较常见（P < 0.001）。逆转频率为27%，每1000人年有158.1次逆转。初始结核反应值越高，预测结果持续为阳性的可能性越大（P < 0.001）。转换频率为15%，每1000人年有82.6次转换。在转换者中，IGRA值各不相同，48%的结核反应<1 IU/mL，41%为1 - 5 IU/mL，仅10% >5 IU/mL。
在移植候选受者的连续IGRA检测过程中发生了大量的转换和逆转。区分真阳性转换者与假阳性是一个值得进一步研究的问题。
