The Effect of QuantiFERON TB Gold Results on the Requirement for Tuberculosis Prophylaxis in Solid Organ Transplant Recipient and Donor Candidates

Öz

Objective: The incidence of tuberculosis in patients undergoing solid organ transplantation is higher than in the normal population. Tuberculosis (TB) is an important cause of morbidity and mortality in these patients. Screening for active or latent TB is required in transplant candidates. The aim of this study was to determine the prevalence of TB in donors and recipient candidates using QuantiFERON TB Gold test (‘QFT-G’) before solid organ transplantation.
Methods: The study included 667 patients who were referred to organ transplantation departments with the preliminary diagnosis of solid organ transplant recipient and donor between 01.07.2019-01.08.2019 and who were tested using QuantiFERON ‘QFT-G’ (In-Tube Method, Cellestis Limited, Australia). Of these patients, 227 were donor candidates and 440 were recipient candidates. Records were reviewed using the hospital information management system, and the results were evaluated retrospectively. Comparisons between the groups in terms of categorical variables were made using chi-square test.
Results: Overall ‘QFT-G’ TB positivity rate was 20.7% in transplant recipient candidates, and was 13.2% in donor candidates. ‘QFT-G’ positivity rate was higher in recipient candidates than donor candidates (p=0.018). ‘QFT-G’positivity rate among solid organ recipient candidates was 19.5% in liver recipients, 21.8% in kidney recipients, 25.0% in heart recipients, and there was no significant difference in terms of positivity rates (p=0.757).
Conclusion: Our study has importance because of being among the first TB screening studies conducted on solid organ transplantation donors and recipients in our country. In addition, the screening of both active and latent TB increases the importance of our study data. Our study demonstrated that solid organ transplantation should also capture both donor and new organ-mediated TB and recipient-induced latent infection. We consider that the data of our study will provide important information about the incidence of active or latent TB before transplantation to both researchers and clinicians in our country.

Anahtar Kelimeler

• QuantiFERON
• transplantation
• tuberculosis
• latent

Solid Organ Nakli Alıcılarında QuantiFERON TB Gold Sonuçlarının Tüberküloz Profilaksisi Gerekliliği Üzerine Etkisi

Öz

Solid organ transplantasyonu yapılan hastalarda tüberküloz insidansı normal popülasyona göre daha yüksektir. Bu hastalarda tüberküloz önemli bir morbidite ve mortalite nedenidir. Transplant adaylarında aktif veya latent tüberküloz için tarama yapılması gereklidir. Bu çalışmada solid organ nakli öncesi donörlerde ve alıcı adaylarında QuantiFERON TB Gold testi kullanılarak tüberküloz prevalansının ortaya konulması amaçlanmıştır. Çalışma 01.07.2019-01.08.2019 tarihleri arasında solid organ nakli alıcısı ve vericisi ön tanısıyla organ nakli bölümlerine başvuran ve QuantiFERON TB Gold Testi (In-Tube Method, Cellestis Limited, Australia) çalışılmış toplam 667 hasta çalışmaya dahil edilmiştir. Bu hastaların 227’si donör adayı, 440’ı alıcı adayıdır. Hastane bilgi yönetim sistemi üzerinden kayıtlar incelenmiş ve retrospektif olarak sonuçlar değerlendirilmiştir. Kategorik değişkenler açısından gruplar arasındaki karşılaştırmalar Ki Kare testi ile yapılmıştır. Transplantasyon alıcı adaylarındaki genel QuantiFERON testi tüberküloz pozitiflik oranı %20.7; verici adaylarında ise %13.2 idi. Alıcı adaylarındaki QuantiFERON pozitiflik oranı verici adaylarına göre anlamlı yüksek bulundu (p=0.018). Solid organ alıcı adayları arasında QuantiFERON pozitiflik oranı karaciğer alıcılarında %19.5, böbrek alıcılarında %21.8, kalp alıcılarında %25.0 idi ve pozitiflik oranları açısından aralarında anlamlı fark yoktu (p=0.757). Çalışmamız ülkemizden solid organ transplantasyonu donör ve alıcılarındaki ilk tüberküloz taramaları arasında olması nedeniyle önem taşımaktadır. Ayrıca hem aktif hem de latent tüberkülozun taranmış olması çalışmamız verilerinin önemini arttırmaktadır. Çalışmamız solid organ transplantasyonu hem donör ve yeni organ kaynaklı tüberküloz hem de alıcı kaynaklı latent enfeksiyonun da yakalanması gerekliliğini ortaya koymuştur. Çalışmamız verilerinin özellikle ülkemizde hem araştırmacılara hem de klinisyenlere nakil öncesi aktif veya latent tüberküloz insidansı ile ilgili önemli bilgi sağlayacağını düşünmekteyiz.

Anahtar Kelimeler

• QuantiFERON
• solid organ nakli
• tüberküloz

Kaynakça

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