Analysis of Indeterminate QuantiFERON Assay Results in Solid Organ Transplant Candidates and Proposed Management Algorithm.

IF 5.3 2区医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2024-09-09 DOI:10.1097/TP.0000000000005195

Chia-Yu Chiu, Maryam Mahmood, Lisa M Brumble, Holenarasipur R Vikram, Elitza S Theel, Elena Beam

{"title":"Analysis of Indeterminate QuantiFERON Assay Results in Solid Organ Transplant Candidates and Proposed Management Algorithm.","authors":"Chia-Yu Chiu, Maryam Mahmood, Lisa M Brumble, Holenarasipur R Vikram, Elitza S Theel, Elena Beam","doi":"10.1097/TP.0000000000005195","DOIUrl":null,"url":null,"abstract":"Background: Identification and treatment of latent tuberculosis infection (LTBI) mitigate the risk of tuberculosis (TB) reactivation after transplantation. TB reactivation is higher in those with indeterminate QuantiFERON (QFT) than those with negative results. Management of indeterminate QFT results in the pretransplant period remains unclear.Methods: We conducted a retrospective study of solid organ transplant (SOT) recipients, 18 y and older, who were screened with QFT assay pretransplantation at Mayo Clinic between January 2010 and June 2023. We examined the frequency of indeterminate QFT results, results of repeat LTBI screening, treatment decisions, and rate of posttransplant TB infection.Results: Of 13 008 patients screened for LTBI before SOT, 736 (6%) patients had indeterminate QFT results. Among these, 247 (34%) underwent a second LTBI screening test, and 39 (5%) received LTBI treatment. Among 247 patients with a repeat LTBI screening test, 185 (75%), 48 (19%), and 14 (6%) were tested by QFT, T-SPOT.TB, or TST, respectively. The repeat QFT remained indeterminate in 160 (86%) patients, whereas all T-SPOT.TB results were negative. Posttransplant TB infection occurred in 2 (0.3%) patients; neither had a second TB screening test pretransplant nor received LTBI treatment.Conclusions: In SOT recipients with indeterminate QFT results at pretransplant evaluation, opting for T-SPOT.TB as a second test may be preferable over repeat QFT. TB infection after transplantation in patients with a pretransplant indeterminate QFT result was rare. Patient management and LTBI treatment in those with indeterminate QFT pretransplant should account for epidemiological risk factors, and shared decision-making is recommended.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":null,"pages":null},"PeriodicalIF":5.3000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TP.0000000000005195","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Identification and treatment of latent tuberculosis infection (LTBI) mitigate the risk of tuberculosis (TB) reactivation after transplantation. TB reactivation is higher in those with indeterminate QuantiFERON (QFT) than those with negative results. Management of indeterminate QFT results in the pretransplant period remains unclear.

Methods: We conducted a retrospective study of solid organ transplant (SOT) recipients, 18 y and older, who were screened with QFT assay pretransplantation at Mayo Clinic between January 2010 and June 2023. We examined the frequency of indeterminate QFT results, results of repeat LTBI screening, treatment decisions, and rate of posttransplant TB infection.

Results: Of 13 008 patients screened for LTBI before SOT, 736 (6%) patients had indeterminate QFT results. Among these, 247 (34%) underwent a second LTBI screening test, and 39 (5%) received LTBI treatment. Among 247 patients with a repeat LTBI screening test, 185 (75%), 48 (19%), and 14 (6%) were tested by QFT, T-SPOT.TB, or TST, respectively. The repeat QFT remained indeterminate in 160 (86%) patients, whereas all T-SPOT.TB results were negative. Posttransplant TB infection occurred in 2 (0.3%) patients; neither had a second TB screening test pretransplant nor received LTBI treatment.

Conclusions: In SOT recipients with indeterminate QFT results at pretransplant evaluation, opting for T-SPOT.TB as a second test may be preferable over repeat QFT. TB infection after transplantation in patients with a pretransplant indeterminate QFT result was rare. Patient management and LTBI treatment in those with indeterminate QFT pretransplant should account for epidemiological risk factors, and shared decision-making is recommended.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

分析实体器官移植候选者的定量FERON检测不确定结果并提出处理算法。

背景：潜伏肺结核感染（LTBI）的鉴定和治疗可降低移植后肺结核（TB）再活的风险。与阴性结果相比，定量因子（QFT）不确定者的结核再活率更高。移植前对不确定的 QFT 结果的处理仍不明确：我们对 2010 年 1 月至 2023 年 6 月期间在梅奥诊所接受 QFT 检测的 18 岁及以上实体器官移植（SOT）受者进行了一项回顾性研究。我们研究了 QFT 结果不确定的频率、LTBI 复筛结果、治疗决定以及移植后结核感染率：在 13 008 名接受 SOT 前 LTBI 筛查的患者中，有 736 名（6%）患者的 QFT 结果不确定。其中，247 人（34%）接受了第二次 LTBI 筛查测试，39 人（5%）接受了 LTBI 治疗。在 247 名接受重复 LTBI 筛查测试的患者中，185 人（75%）、48 人（19%）和 14 人（6%）分别接受了 QFT、T-SPOT.TB 或 TST 测试。有 160 名（86%）患者的 QFT 复检结果仍不确定，而所有 T-SPOT.TB 结果均为阴性。2例（0.3%）患者在移植后感染了结核病；这2例患者在移植前都没有进行第二次结核病筛查，也没有接受过LTBI治疗：结论：对于在移植前评估中QFT结果不确定的SOT受者，选择T-SPOT.TB作为第二次检测可能比重复QFT更好。移植前 QFT 结果不确定的患者在移植后感染结核病的情况很少见。移植前 QFT 结果不确定的患者的管理和 LTBI 治疗应考虑流行病学风险因素，建议共同决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.