Sarmiento Elizabeth, Ezzahouri Ikram, Jimenez-Lopez Maricela, Limay Carré Kristofer M, Alonso Rocio, Ortiz-Bautista Carlos, Salcedo Plaza Magdalena, Rodríguez-Ferrero Maria Luisa, Padilla-Machaca Pedro Martin, Cerron Ana, Chaman Jose Carlos, Vionnet Salvo Ana P, Carbone Javier
Department of Immunology, Gregorio Marañon General University Hospital, Madrid, Spain.
Department of Immunology, Gomez Ulla Central Defense Hospital, Madrid, Spain.
Ann Transplant. 2025 Jan 21;30:e946233. doi: 10.12659/AOT.946233.
BACKGROUND Infection is a cause of morbidity and mortality in solid-organ transplantation (SOT). We evaluated a new score that is applied during the first month after transplantation. The score comprises biomarkers of innate and acquired immunity to predict infections in SOT. MATERIAL AND METHODS Prospectively collected blood samples from 377 heart, liver, or kidney recipients were analyzed at 2 centers in Madrid (Spain) and Lima (Peru). Biomarkers were tested before transplantation and at days 7 and 30 after transplantation. During the first 6 months after transplantation, 183 (48.5%) patients developed severe infections (bacterial infections and/or CMV disease). Risk for severe infection was assessed using logistic regression analysis. We designed a score, the routine immunity score (RIS2020), which is based on the sum of the hazard ratios (HRs) of each biomarker. RESULTS The risk factors for severe infection were as follows: Moderate IgG hypogammaglobulinemia (IgG <600 mg/dL at days 7 or 30, HR 2.07, 95% CI 1.37-3.12, p=0.0005, 2 points), CD4 <400 cells/uL at day 30 (HR 1.76, 95% CI 1.03-3.04, p=0.039, 2 points), C3 <80 mg/dL at day 30 (HR 2.18, 95%CI 1.16-4.06, p=0.014, 2 points), and CRP >3 mg/dL at day 30 (HR 2.11, 95% CI 1.12-3.97, p=0.02, 2 points). In patients with ≥4 points, the HR for infection was 5.18 (95% CI 3.06-8.75; p<0.001). RIS2020 was an independent predictor of severe infection in multivariate models. CONCLUSIONS An immunological score combining moderate IgG hypogammaglobulinemia and other parameters of innate and acquired immunity could better identify the risk for severe infection in SOT.
背景 感染是实体器官移植（SOT）中发病和死亡的一个原因。我们评估了一种在移植后第一个月应用的新评分。该评分包含先天免疫和获得性免疫的生物标志物，用于预测SOT中的感染情况。材料与方法 在马德里（西班牙）和利马（秘鲁）的2个中心，对前瞻性收集的377名心脏、肝脏或肾脏移植受者的血样进行分析。在移植前以及移植后第7天和第30天检测生物标志物。在移植后的前6个月，183名（48.5%）患者发生了严重感染（细菌感染和/或巨细胞病毒病）。使用逻辑回归分析评估严重感染的风险。我们设计了一种评分，即常规免疫评分（RIS2020），它基于每个生物标志物的风险比（HR）之和。结果 严重感染的危险因素如下：中度IgG低丙种球蛋白血症（第7天或第30天IgG<600mg/dL，HR 2.07，95%CI 1.37 - 3.12，p = 0.0005，2分）、第30天CD4<400细胞/μL（HR 1.76，95%CI 1.03 - 3.04，p = 0.039，2分）、第30天C3<80mg/dL（HR 2.18，95%CI 1.16 - 4.06，p = 0.014，2分）以及第30天CRP>3mg/dL（HR 2.11，95%CI 1.12 - 3.97，p = 0.02，2分）。在得分≥4分的患者中，感染的HR为5.18（95%CI 3.06 - 8.75；p<0.001）。在多变量模型中，RIS2020是严重感染的独立预测指标。结论 一种结合中度IgG低丙种球蛋白血症以及先天免疫和获得性免疫其他参数的免疫评分，能够更好地识别SOT中严重感染的风险。
