Evaluation of Quantiferon®‐Monitor as a biomarker of immunosuppression and predictor of infection in lung transplant recipients

Abstract

Background: Optimizing immunosuppression in lung transplant recipients (LTR) is crucially important in minimizing the risk of infection and rejection. Quantiferon®-Monitor (QFM) is a candidate immune function biomarker which has not yet been rigorously evaluated in the lung transplant setting. The aim of this prospective cohort study was to explore relationships between QFM results, immunosuppression, and infection/rejection in LTR. Methods: QFM, which measures interferon-γ after stimulation with innate and adaptive immune antigens, was tested before and at 2, 6, 12, 24 and 52 weeks post-transplant. Immunosuppression relationships were assessed with linear mixed effects models. Clinical outcomes were analyzed based on the preceding QFM result. Results: Eighty LTR were included. Median pre-transplant QFM levels were 171 IU/ mL (IQR 45-461), decreasing to 3 IU/mL (IQR 1-8) at 2 weeks post-transplant then progressively recovering toward baseline with time from transplant. Prednisolone was strongly inversely associated with QFM level (0.1 mg/kg dose increase correlating with 88 IU/mL QFM decrease, 95% CI 61-114, P < .001). Patients with QFM values <10 and <60 IU/mL were more likely to develop a serious opportunistic infection

Assessment of Functional Capacity of Immune System in Patients with Multiple Sclerosis using QuantiFERON Monitor

“…Never before has such a study been conducted. QFM been used in transplantation medicine [6,9,10]. In their publications, the authors state that QFM can identify excessively immunosuppressed patients, can demonstrate the recovery of patient immunity, or can predict the risk of developing an infection in immunosuppressed patients.…”

“…The QuantiFERON ® -Monitor (QFM, Qiagen, Germantown, MD, USA) is a novel whole blood immune function assay that measures IFN-γ production following the stimulation of innate cells with R848 compound and adaptive immune T cells using antiCD3 monoclonal antibody [6]. The dual stimulation with innate and adaptive ligands confers a significant advantage over single-stimulant assays.…”

“…Although QFM was developed to provide an objective marker of the complex immune response [6,8] and has so far only been used in transplantation (postallogeneic hematopoietic cell transplantation [9], lung transplantation [6], kidney transplantation [10]), infectious medicine (HIV [11], COVID-19 [12]), and hepatology (cirrhosis [13]), for assessment in neurology (MS patients) has never been used before.…”

Pathogen‐agnostic immune biomarkers that predict infection after solid organ transplantation

“…QFM was studied in a second cohort of lung recipients who underwent testing before transplant and at 2, 6, 12, 24, and 52 weeks post transplant to examine the association between QFM and all infections, serious infections, and OIs (which included viral, fungal, Nocardia, and Mycobacterial pathogens) 86 . QFM values were globally low following lung transplant and could not discriminate between patients with and without infection.…”

A Clinical Model to Predict the Occurrence of Select High-risk Infections in the First Year Following Heart Transplantation

“…Novel serum assays seek to quantify degree of immune suppression or predict the probability of specific infection, such as cytomegalovirus (CMV). [1][2][3][4] Although useful in certain clinical settings, such tests are still finding their role in everyday practice, as they require specialized laboratories, often have caveats in interpretation or generalizability, and are expensive. Moreover, the information they provide may lack important modifying clinical factors.…”