Mount Sinai School of Medicine, Division of Nephrology Recanati Miller Transplantation Institute, Immunology Institute New York, New York, USA.
Curr Opin Organ Transplant. 2008 Aug;13(4):419-24. doi: 10.1097/MOT.0b013e3283071463.
Chronic injury and late allograft loss remain major causes of morbidity in clinical transplantation. Biomarkers that can reliably assess the risk of posttransplant complications are required to direct and individualize therapy aimed at prolonging graft survival and improving patient health. The purpose of this review is to provide a framework for understanding how to use biomarkers in the context of clinical transplantation and to summarize current data on available noninvasive cellular-based immune monitoring methods to predict transplant outcome.
New microarray and gene profiling data reveal peripheral blood cell gene expression patterns that identify operational tolerance, raising the possibility that the measurements can be used to direct immunosuppression withdrawal. Additional data support the use of selective urine gene products and soluble CD30 measurements in serum as reliable biomarkers of acute graft injury. Finally, recent studies demonstrate that measurement of T-cell alloimmunity by cytokine enzyme-linked immunospot is a promising, supplementary pretransplant risk assessment tool.
Recently published studies in organ transplantation suggest that results derived from assays focused on markers of T-cell immunity can segregate transplant candidates or recipients into high and low-risk subgroups for posttransplant graft injury. Larger prospective studies are needed, however, before any proposed biomarker can be incorporated into the transplant physicians' armamentarium to guide individualized therapeutic decision-making.
慢性损伤和晚期移植物丢失仍然是临床移植中发病率的主要原因。需要能够可靠评估移植后并发症风险的生物标志物，以便指导和个体化治疗，延长移植物的存活时间，改善患者的健康状况。本文的目的是提供一个框架，了解如何在临床移植的背景下使用生物标志物，并总结目前关于非侵入性细胞免疫监测方法的可用数据，以预测移植结果。
新的微阵列和基因表达谱数据揭示了外周血细胞基因表达模式，可识别免疫耐受，这使得这些测量值有可能被用于指导免疫抑制剂的停药。其他数据支持选择性尿基因产物和血清可溶性 CD30 测量作为急性移植物损伤的可靠生物标志物。最后，最近的研究表明，通过细胞因子酶联免疫斑点测定测量 T 细胞同种异体免疫是一种有前途的、补充性的移植前风险评估工具。
最近发表的器官移植研究表明，针对 T 细胞免疫标志物的检测结果可以将移植候选者或受者分为高风险和低风险亚组，以预测移植后移植物损伤。然而，在任何拟议的生物标志物被纳入移植医生的治疗方案之前，都需要进行更大的前瞻性研究，以指导个体化的治疗决策。
