Aim: To develop a practical score based on readily available immunological parameters to predict the risk of infection in KT recipients.
Methods: We included 245 patients who undergo a KT between November 2008 and July 2011. Total lymphocyte count and peripheral blood lymphocyte subpopulations (PBLSs), serum immunoglobulin levels (IgG, IgA and IgM), and serum complement levels (C3 and C4) were investigated at baseline and months 1 and 6. Predictors for infection in different post-transplant periods (intermediate [months 1-6] and late [>6 months]) were assessed by Cox regression models. One point was assigned to each of the following: IgG hypogammaglobulinemia (<700 mg/dL), C3 hypocomplementemia (<83 mg/dL), and low counts in some PBLSs (CD8+ T-cell <0.200 x 103/ΜL at month 1 and CD3+ T-cell <0.500 x 103/ΜL at month 6). The index was collapsed into 3 groups: low- (score of 0), intermediate- (score of 1-2), and high-risk (score of 3). Receiver operating characteristic (ROC) curves were used to analyze the diagnostic accuracy of the score at months 1 and 6.
Results: According to the score value at month 1, cumulative incidences of overall infection at the end of the intermediate period were 19.3%, 41.8% and 77.8% in low-, intermediate- and high risk-groups, respectively (P <0.001). Cumulative incidences of opportunistic infection were 8.8%, 25.9% and 55.6%, respectively (P = 0.001). In the multivariate analysis, compared to the low-risk group, the hazard ratios for overall infection in the intermediate- and high-risk groups were 1.96 (95% confidence interval [CI]: 1.01-3.79) and 4.14 (95% CI: 1.82-9.41). The AUC of the model at month 1 for predicting infection in the intermediate period was 0.68 (95% CI: 0.61-0.75). In the late period, cumulative incidences of overall infection were 8.6%, 23.2% and 50.0% in low-, intermediate- and high risk-groups, respectively (P = 0.011). The AUC of the model at month 6 for predicting late infection was 0.65 (95% CI: 0.55-0.75).
Conclusions: A simple score, on the basis of scheduled monitoring of PBLSs and serum IgG and C3 levels, is useful for evaluating the risk of infection after KT.
To cite this abstract in AMA style:Fernández-Ruiz M, López-Medrano F, Allende L, Varela P, Juan RSan, Lumbreras C, Andrés A, Polanco N, Morales J, Paz-Artal E, Aguado J. Simple Post-Transplant Immunological Score Accurately Predicts the Risk of Infection in Kidney Transplant (KT) Recipients, A [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/simple-post-transplant-immunological-score-accurately-predicts-the-risk-of-infection-in-kidney-transplant-kt-recipients-a/. Accessed November 23, 2020.
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