Assessing relative risks of infection and rejection: a meta-analysis using an immune function assay.

Abstract:

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.

journal_name

Transplantation

journal_title

Transplantation

authors

Kowalski RJ,Post DR,Mannon RB,Sebastian A,Wright HI,Sigle G,Burdick J,Elmagd KA,Zeevi A,Lopez-Cepero M,Daller JA,Gritsch HA,Reed EF,Jonsson J,Hawkins D,Britz JA

doi

10.1097/01.tp.0000234837.02126.70

subject

Has Abstract

pub_date

2006-09-15 00:00:00

pages

663-8

issue

5

eissn

0041-1337

issn

1534-6080

pii

00007890-200609150-00011

journal_volume

82

pub_type

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