Assessing relative risks of infection and rejection: A meta-analysis using an immune function assay
Assessing relative risks of infection and rejection: A meta-analysis using an immune function assay
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DOI：
10.1097/01.tp.0000234837.02126.70
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发表时间：
2006-09-15
期刊：
影响因子：
6.2
通讯作者：
Britz, Judith A.
中科院分区：
文献类型：
--
作者：
Kowalski, Richard J.;Post, Diane R.;Britz, Judith A.
背景长期使用免疫抑制剂与移植受者显著的发病率和死亡率相关。一个简单的全血检测，有美国食品和药物管理局的许可，直接评估同种异体移植受体的免疫功能的净状态，以更好地个性化治疗。使用Cylex ImmuKnow分析对来自美国10个中心的504例实体器官移植受者（心脏、肾脏、肾-胰腺、肝脏和小肠）进行荟萃分析。在移植后的不同时间从受体中采集血液样本，并与临床过程（稳定，排斥，感染）进行比较。在这项分析中，发生了39例活检证实的细胞排斥反应和66例诊断的感染。感染或排斥反应的比值比计算的基础上测量的免疫反应值。免疫应答值为25 ng/ml三磷酸腺苷（ATP）的受体发生感染的可能性是免疫应答较强的受体的12倍（95%置信度为4至36）。类似地，具有700 ng/ml ATP的免疫应答的受者比具有较低免疫应答值的受者更有可能发生细胞排斥反应30倍（95%置信度为8至112）。值得注意的是在中等免疫应答区（280 ng/ml ATP）中感染和排斥的比值比曲线的交叉点。风险曲线的交叉点为实体器官肿瘤的免疫功能提供了免疫学靶点。这些数据表明，Cylex ImmuKnow检测试剂盒具有较高的阴性预测值，并提供了一个目标免疫反应区，用于最大限度地降低风险并管理患者以达到稳定。
Background. Long-term use of immunosuppressants is associated with significant morbidity and mortality in transplant recipients. A simple whole blood assay that has U.S. Food and Drug Administration clearance directly assesses the net state of immune function of allograft recipients for better individualization of therapy. A meta-analysis of 504 solid organ transplant recipients (heart, kidney, kidney-pancreas, liver and small bowel) from 10 U.S. centers was performed using the Cylex ImmuKnow assay.Methods. Blood samples were taken from recipients at various times posttransplant and compared with clinical course (stable, rejection, infection). In this analysis, 39 biopsy-proven cellular rejections and 66 diagnosed infections occurred. Odds ratios of infection or rejection were calculated based on measured immune response values.Results. A recipient with an immune response value of 25 ng/ml adenosine triphosphate (ATP) was 12 times (95% confidence of 4 to 36) more likely to develop an infection than a recipient with a stronger immune response. Similarly, a recipient with an immune response of 700 ng/ml ATP was 30 times (95% confidence of 8 to 112) more likely to develop a cellular rejection than a recipient with a lower immune response value. Of note is the intersection of odds ratio curves for infection and rejection in the moderate immune response zone (280 ng/ml ATP). This intersection of risk curves provides an immunological target of immune function for solid organ recipients.Conclusion. These data show that the Cylex ImmuKnow assay has a high negative predictive value and provides a target immunological response zone for minimizing risk and managing patients to stability.