Decreased levels of serum complement C3 and natural killer cells add to the predictive value of total immunoglobulin G for severe infection in heart transplant recipients

Sarmiento, E.; Pozo, N. Del; Gallego, A.; Fernàndez-Yáñez, J.; Palomo, Jesús; Villa, Adolfo; Ruíz, Manuel; Muñóz, Patricia; Rodríguez, C.; Rodrı́guez-Molina, J.; Navarro, J.; Kotsch, Katja; Fernández‐Cruz, Eduardo; Carbone, J.

doi:10.1111/j.1399-3062.2012.00757.x

Cited by 24 publications

(38 citation statements)

References 22 publications

(26 reference statements)

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Section: Non-pathogen-specific Monitoringmentioning

confidence: 99%

“…35 Comparable findings have been reported for liver 36 and heart transplant recipients. 37 Unfortunately, the only intervention that seems feasible in a patient with low complement levels consists of decreasing immunosuppression, which in turn could increase the risk of graft rejection. The functional status of the lectin activation pathway may be specifically explored by assessing the serum concentrations of mannose-binding lectin (MBL), which in turn are largely determined by various polymorphisms occurring in the mbl2 gene or its promoter region.…”

Section: Serum Immunoglobulin Levelsmentioning

confidence: 99%

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Clinical immune‐monitoring strategies for predicting infection risk in solid organ transplantation

2014

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Infectious complications remain a leading cause of morbidity and mortality after solid organ transplantation (SOT), and largely depend on the net state of immunosuppression achieved with current regimens. Cytomegalovirus (CMV) is a major opportunistic viral pathogen in this setting. The application of strategies of immunological monitoring in SOT recipients would allow tailoring of immunosuppression and prophylaxis practices according to the individual's actual risk of infection. Immune monitoring may be pathogen-specific or nonspecific. Nonspecific immune monitoring may rely on either the quantification of peripheral blood biomarkers that reflect the status of a given arm of the immune response (serum immunoglobulins and complement factors, lymphocyte sub-populations, soluble form of CD30), or on the functional assessment of T-cell responsiveness (release of intracellular adenosine triphosphate following a mitogenic stimulus). In addition, various methods are currently available for monitoring pathogen-specific responses, such as CMV-specific T-cell-mediated immune response, based on interferon-γ release assays, intracellular cytokine staining or main histocompatibility complex-tetramer technology. This review summarizes the clinical evidence to date supporting the use of these approaches to the post-transplant immune status, as well as their potential limitations. Intervention studies based on validated strategies for immune monitoring still need to be performed.

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Section: Non-pathogen-specific Monitoringmentioning

confidence: 99%

Section: Serum Immunoglobulin Levelsmentioning

confidence: 99%

Clinical immune‐monitoring strategies for predicting infection risk in solid organ transplantation

2014

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“…Immunoglobulin (Ig)G hypogammaglobulinaemia was investigated as a risk factor for infection in heart recipients by Avery and collaborators at the Cleveland Clinic in retrospective single-centre studies [3]. We have confirmed these findings in prospective single-centre studies evaluating the role of IgG hypogammaglobulinaemia as a risk factor of severe infection in heart recipients who received non-cytolytic induction therapy with anti-CD25 monoclonal antibodies [4,5]. In a recent prospective multi-centre national study, we assessed the usefulness of a panel of humoral immunity biomarkers in 267 heart recipients in Spain [6].…”

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confidence: 74%

Intravenous immunoglobulin as an intervention strategy of risk factor modification for prevention of severe infection in heart transplantation

et al. 2014

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“…There are several studies that have examined the use of a composite immune score in SOT recipients but these are difficult to compare directly with ours . The majority of these studies have been performed in the early post‐transplant period, whereas our study specifically examined patients who were stable on immunosuppression and some months or years post‐transplant (median time from transplant 4.1 years).…”

Section: Discussionmentioning

confidence: 99%

“…32 There are several studies that have examined the use of a composite immune score in SOT recipients but these are difficult to compare directly with ours. [13][14][15]23,26 The majority of these studies have diction models. Importantly, we did not simultaneously examine rates of rejection which would be necessary in any study looking to reduce immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

A simple score can identify kidney transplant recipients at high risk of severe infection over the following 2 years

Dendle

Polkinghorne

Mulley

et al. 2019

Transplant Infectious Dis

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Background The aim of this study was to determine whether a composite score of simple immune biomarkers and clinical characteristics could predict severe infections in kidney transplant recipients. Methods We conducted a prospective study of 168 stable kidney transplant recipients who underwent measurement of lymphocyte subsets, immunoglobulins, and renal function at baseline and were followed up for 2 years for the development of any severe infections, defined as infection requiring hospitalization. A point score was developed to predict severe infection based on logistic regression analysis of factors in baseline testing. Results Fifty‐nine (35%) patients developed severe infection, 36 (21%) had two or more severe infections, and 3 (2%) died of infection. A group of 19 (11%) patients had the highest predicted infectious risk (>60%), as predicted by the score. Predictive variables were mycophenolate use, graft function, CD4+, and natural killer cell number. The level of immunosuppression score had an area under the receiver operating curve of 0.75 (95% CI: 0.67‐0.83). Conclusion Our level of immunosuppression score for predicting the development of severe infection over 2 years has sufficient prognostic accuracy for identification of high‐risk patients. This data can inform research that examines strategies to reduce the risks of infection.

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Decreased levels of serum complement C3 and natural killer cells add to the predictive value of total immunoglobulin G for severe infection in heart transplant recipients

Abstract: Data suggest that early immune monitoring including C3, IgG2, and NK cell testing in addition to IgG concentrations is useful when attempting to identify the risk of infection in heart transplant recipients.

Cited by 24 publications

References 22 publications

Clinical immune‐monitoring strategies for predicting infection risk in solid organ transplantation

Clinical immune‐monitoring strategies for predicting infection risk in solid organ transplantation

Intravenous immunoglobulin as an intervention strategy of risk factor modification for prevention of severe infection in heart transplantation

A simple score can identify kidney transplant recipients at high risk of severe infection over the following 2 years

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