Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, Spain.
Arch Bronconeumol. 2021 Nov;57(11):690-696. doi: 10.1016/j.arbr.2020.12.012.
Immune cell functional assay (ImmuKnow®) is a non-invasive method that measures the state of cellular immunity in immunosuppressed patients. We studied the prognostic value of the assay for predicting non-cytomegalovirus (CMV) infections in lung transplant recipients.
A multicenter prospective observational study of 92 patients followed up from 6 to 12 months after transplantation was performed. Immune cell functional assay was carried out at 6, 8, 10, and 12 months.
Twenty-three patients (25%) developed 29 non-CMV infections between 6 and 12 months post-transplant. At 6 months, the immune response was moderate (ATP 225-525ng/mL) in 14 (15.2%) patients and low (ATP<225ng/mL) in 78 (84.8%); no patients had a strong response (ATP≥525ng/mL). Only 1 of 14 (7.1%) patients with a moderate response developed non-CMV infection in the following 6 months compared with 22 of 78 (28.2%) patients with low response, indicating sensitivity of 95.7%, specificity of 18.8%, positive predictive value (PPV) of 28.2%, and negative predictive value (NPV) of 92.9% (AUC 0.64; p=0.043). Similar acute rejection rates were recorded in patients with mean ATP≥225 vs. <225ng/mL during the study period (7.1% vs. 9.1%, p=0.81).
Although ImmuKnow® does not seem useful to predict non-CMV infection, it could identify patients with a very low risk and help us define a target for an optimal immunosuppression.
免疫细胞功能检测（ImmuKnow®）是一种非侵入性方法，可测量免疫抑制患者的细胞免疫状态。我们研究了该检测对预测肺移植受者非巨细胞病毒（CMV）感染的预后价值。
对 92 例患者进行了一项多中心前瞻性观察研究，这些患者在移植后 6 至 12 个月进行了随访。在 6、8、10 和 12 个月时进行了免疫细胞功能检测。
在移植后 6 至 12 个月期间，23 例（25%）患者发生 29 例非 CMV 感染。在 6 个月时，14 例（15.2%）患者的免疫反应为中度（ATP 225-525ng/mL），78 例（84.8%）患者的免疫反应为低度（ATP<225ng/mL）；没有患者表现出强烈反应（ATP≥525ng/mL）。在接下来的 6 个月中，仅有 1 例（7.1%）中度反应患者发生非 CMV 感染，而低度反应患者中则有 22 例（28.2%）发生，表明敏感性为 95.7%，特异性为 18.8%，阳性预测值（PPV）为 28.2%，阴性预测值（NPV）为 92.9%（AUC 0.64；p=0.043）。在研究期间，平均 ATP≥225ng/mL 与<225ng/mL 的患者记录到相似的急性排斥反应率（7.1%比 9.1%，p=0.81）。
尽管 ImmuKnow®似乎不能用于预测非 CMV 感染，但它可以识别出风险非常低的患者，并帮助我们确定最佳免疫抑制的目标。
