Gotor-Rivera Alfonso, de Jorge-Huerta Lucia, Silva José Tiago, Fernández-Ruiz Mario, Rodríguez-Goncer Isabel, Pérez-Jacoiste Asín María Asunción, Ruiz-Merlo Tamara, Heredia-Mena Carlos, González-Monte Esther, Polanco Natalia, San-Juan Rafael, Andrés Amado, Aguado José María, López-Medrano Francisco
Servicio de Dermatología, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, España.
Unidad de Enfermedades Infecciosas, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, España.
Rev Esp Quimioter. 2025 May 14;38(3):222-227. doi: 10.37201/req/002.2025. Epub 2025 Mar 5.
The increased risk of tuberculosis (TB) reactivation in solid organ transplant recipients supports the recommendation of screening for latent tuberculosis infection (LTBI). Adherence to available screening tests has not been studied in the kidney transplant (KT) population. We aimed to assess screening compliance within the ATALANTA-DOS population study.
ATALANTA-DOS studied an intervention bundle aimed at preventing infection in KT recipients. We compared LTBI screening rates between the pre-intervention (February 2016 - September 2017) and intervention (February 2018 - September 2019) cohorts and evaluated adherence rates between the interferon-gamma release assay (IGRA) and the tuberculin skin test (TST).
A total of 307 KT recipients were included (155 in the pre-intervention cohort; 148 in the intervention cohort). A systematic assessment of screening compliance by an infectious disease specialist on day +30 post-KT improved LTBI screening adherence (82.6% [114/138] vs 1.3% [2/155]; p-value <0.001). In the intervention cohort, compliance was higher with IGRA (83.3% [52/62]) than with TST (68.1% [49/72]). Two cases of LTBI were detected in the pre-intervention cohort and five in the intervention cohort (4.4% [5/114]). All patients completed LTBI treatment after ruling out active TB. No cases of active TB were identified during follow-up.
Systematic evaluation of LTBI screening compliance significantly increased screening completion rates among KT recipients. IGRA-based strategies increased screening compliance, supporting their implementation over TST for LTBI screening among KT recipients. Increased adherence would allow a more targeted and effective treatment of LTBI.
实体器官移植受者中结核病（TB）复发风险增加，这支持了对潜伏性结核感染（LTBI）进行筛查的建议。尚未在肾移植（KT）人群中研究对现有筛查试验的依从性。我们旨在评估ATALANTA - DOS人群研究中的筛查依从性。
ATALANTA - DOS研究了旨在预防KT受者感染的一组干预措施。我们比较了干预前（2016年2月 - 2017年9月）和干预后（2018年2月 - 2019年9月）队列之间的LTBI筛查率，并评估了干扰素 - γ释放试验（IGRA）和结核菌素皮肤试验（TST）之间的依从率。
共纳入307名KT受者（干预前队列155名；干预后队列148名）。在KT术后第30天由传染病专家对筛查依从性进行系统评估，提高了LTBI筛查依从性（82.6% [114/138] 对1.3% [2/155]；p值<0.001）。在干预队列中，IGRA的依从性（83.3% [52/62]）高于TST（68.1% [49/72]）。干预前队列中检测到2例LTBI，干预后队列中检测到5例（4.4% [5/114]）。所有患者在排除活动性结核病后完成了LTBI治疗。随访期间未发现活动性结核病病例。
对LTBI筛查依从性进行系统评估显著提高了KT受者的筛查完成率。基于IGRA的策略提高了筛查依从性，支持在KT受者中采用IGRA而非TST进行LTBI筛查。依从性提高将使LTBI的治疗更具针对性和有效性。
