Infectious Diseases Department, Groupe Hospitalier Henri-Mondor/Albert Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France.
Nephrology and Renal Transplantation Department, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri-Mondor/Albert-Chenevier, AP-HP (Assistance Publique-Hôpitaux de Paris), Créteil, France.
Transpl Infect Dis. 2021 Aug;23(4):e13607. doi: 10.1111/tid.13607. Epub 2021 Apr 13.
Recommended preventive strategies before kidney transplantation include screening and treatment of latent tuberculosis infection (LTBI), and updating of the recommended vaccines. We prospectively evaluated in dedicated infectious diseases consultations, from 2014 to 2018, the clinical and vaccination data of new adult kidney allograft candidates. Patients were offered an updated vaccination schedule, if appropriate, and were screened for LTBI using chest imaging and interferon gamma release assay (IGRA). Overall, 467 patients with median age of 58 [46-66] years were evaluated, of whom 302 patients (65%) were men (sex ratio 1.83), and 333 (71%) were on dialysis. Main causes of renal insufficiency were diabetes (25%) and autoimmune nephropathies (18%). The vaccination coverage was low and varied according to the different types of vaccines and patients. Vaccination or immunization rates were 24%, 6%, 54%, and 51% for tetanus-diphtheria-polio-acellular pertussis, Pneumococcus, hepatitis B, and seasonal influenza, respectively. ID consultation successfully rose patients' vaccinations coverage, in fulfillment with recommendations, in 465 (99%) patients. LTBI treatment was administered in 78 (16.7%) patients and caused drug-related adverse events in 9 (11%). A dedicated infectious disease consultation should become a critical tool for coordinating infection prevention strategies.
在肾移植前,建议采取的预防策略包括筛查和治疗潜伏性结核感染(LTBI),以及更新推荐的疫苗。我们前瞻性地在专门的传染病咨询中,评估了 2014 年至 2018 年间新的成年肾移植候选者的临床和疫苗接种数据。如果合适,我们为患者提供了更新的疫苗接种计划,并使用胸部影像学和干扰素γ释放试验(IGRA)筛查 LTBI。共有 467 名中位年龄为 58 [46-66] 岁的患者接受了评估,其中 302 名患者(65%)为男性(性别比 1.83),333 名患者(71%)正在接受透析。肾功能不全的主要原因是糖尿病(25%)和自身免疫性肾病(18%)。疫苗接种覆盖率较低,且根据不同类型的疫苗和患者而有所不同。破伤风、白喉、脊髓灰质炎、无细胞百日咳、肺炎球菌、乙型肝炎和季节性流感的疫苗接种或免疫率分别为 24%、6%、54%和 51%。传染病咨询成功地提高了 465 名(99%)患者的疫苗接种覆盖率,符合建议。78 名(16.7%)患者接受了 LTBI 治疗,9 名(11%)患者出现了与药物相关的不良反应。专门的传染病咨询应该成为协调感染预防策略的重要工具。