Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Orthop Surg. 2021 Dec;13(4):564-568. doi: 10.4055/cios21031. Epub 2021 Nov 15.
Given the incubation period of viral diseases, a secondary blood test should be performed at least 3-6 months after the first test to ensure the safety of allogenic bone grafts obtained from living donors in some tissue banks. The allograft is discarded if a secondary blood test was unavailable. The secondary blood test can be replaced with a nucleic acid amplification test (NAT) to reduce the discarded allograft. The purpose of this study was to analyze the comparative efficiency of secondary blood test and NAT to determine the donor suitability of allogenic bone grafts.
Allogenic bones were retrieved from 452 living donors between January 2013 and December 2019. A secondary blood test was conducted in 182 patients and NAT was performed in 270 patients. The average age of donors was 69 years (range, 33-87 years). They included 86 men and 366 women. The initial blood tests including hepatitis B, hepatitis C, AIDS, and syphilis were conducted before retrieving grafts. The results were analyzed after the secondary blood test was performed at least 3 to 6 months after the first test because of the incubation period of the viral diseases. NAT was performed within 2 months after the first blood test.
Sixty-seven of the 452 cases (14.8%) were discarded. In the secondary blood test group, 50 out of 182 cases (27.4%), and in the NAT group, 17 out of 270 cases (6.3%) were discarded. None of the 132 donors tested positive in the secondary blood test after testing negative in the first test.
It is extremely rare that the secondary blood test yields positive results in donors who tested negative in the initial test. However, quite a few grafts are discarded only because the secondary blood test is not available. In terms of economics and ethics, the secondary blood test may not be necessary or if required, a single test such as NAT for infectious diseases may be performed to determine donor suitability of allogenic bone.
鉴于病毒疾病的潜伏期，一些组织库为了确保从活体供者获取的同种异体骨移植物的安全性，应在首次检测后至少 3-6 个月进行二次血液检测。如果无法进行二次血液检测，则移植物将被丢弃。如果无法进行二次血液检测，可以使用核酸扩增检测（NAT）代替，以减少丢弃的同种异体移植物。本研究旨在分析二次血液检测和 NAT 的比较效率，以确定同种异体骨移植物供者的适宜性。
2013 年 1 月至 2019 年 12 月期间，从 452 名活体供者中取出同种异体骨。对 182 例患者进行二次血液检测，对 270 例患者进行 NAT 检测。供者的平均年龄为 69 岁（范围为 33-87 岁）。供者包括 86 名男性和 366 名女性。在取出移植物之前，进行了包括乙型肝炎、丙型肝炎、艾滋病和梅毒在内的初始血液检测。由于病毒疾病的潜伏期，首次检测后至少 3-6 个月进行二次血液检测后，对结果进行了分析。首次血液检测后 2 个月内进行了 NAT。
452 例中有 67 例（14.8%）被丢弃。在二次血液检测组中，182 例中有 50 例（27.4%），在 NAT 组中，270 例中有 17 例（6.3%）被丢弃。首次检测结果为阴性，而在二次检测中，没有 132 例供者的结果为阳性。
在初始检测结果为阴性的供者中，二次血液检测结果呈阳性的情况极为罕见。然而，由于无法进行二次血液检测，仍有相当多的移植物被丢弃。从经济和伦理角度来看，二次血液检测可能没有必要，或者如果需要，仅对传染病进行单次检测，如 NAT，即可确定同种异体骨的供者适宜性。
