两种不同技术量化cmv特异性细胞介导免疫在中度危险血清阳性肾移植受者中的诊断性能

IF 2.6 4区 医学 Q3 IMMUNOLOGY Transplant Infectious Disease Pub Date : 2025-01-10 DOI:10.1111/tid.14437
Mario Fernández-Ruiz, Marcos Nuévalos, Isabel Rodríguez-Goncer, Estéfani García-Ríos, Tamara Ruiz-Merlo, Natalia Redondo, Hernando Trujillo, Esther González, Natalia Polanco, José María Caso, Eduardo Aparicio-Minguijón, Francisco López-Medrano, Rafael San Juan, Amado Andrés, Pilar Pérez-Romero, José María Aguado
{"title":"两种不同技术量化cmv特异性细胞介导免疫在中度危险血清阳性肾移植受者中的诊断性能","authors":"Mario Fernández-Ruiz, Marcos Nuévalos, Isabel Rodríguez-Goncer, Estéfani García-Ríos, Tamara Ruiz-Merlo, Natalia Redondo, Hernando Trujillo, Esther González, Natalia Polanco, José María Caso, Eduardo Aparicio-Minguijón, Francisco López-Medrano, Rafael San Juan, Amado Andrés, Pilar Pérez-Romero, José María Aguado","doi":"10.1111/tid.14437","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant (KT) recipients at intermediate risk for cytomegalovirus (CMV) infection constitute a potential target for individualized prevention strategies informed by the CMV-specific cell-mediated immunity (CMV-CMI). The optimal method for the functional assessment of CMV-CMI in this group remains unclear.</p><p><strong>Methods: </strong>We included 74 CMV-seropositive KT recipients that did not receive T-cell-depleting induction and were managed by preemptive therapy. CMV-CMI was monitored at baseline and months 1, 3, 6, and 12 by intracellular cytokine staining (ICS) and a interferon (IFN)-γ-release assay (QuantiFERON-CMV [QTF-CMV]). Both methods were compared for discriminative capacity (areas under the receiving operating characteristic curve [auROCs]) and diagnostic accuracy to predict protection against high-level (≥1000 IU/mL) CMV DNAemia and/or disease.</p><p><strong>Results: </strong>Eighteen patients (24.3%) experienced high-level CMV DNAemia or disease. There were no significant differences in the discriminative capacity to predict protection of CMV-specific CD8+ (auROC: 0.719) and CD4+ T-cell counts (auROC: 0.664) enumerated by ICS and IFN-γ production measured by QTF-CMV (auROC: 0.666). Optimal cutoff values of ≥9.8 CMV-specific CD4+ T-cells/µL and ≥5.7 CD8+ T-cells/µL by ICS yielded excellent specificity (95.7% and 86.9%, respectively) and positive predictive values (PPVs) (>98.0%), but a sensitivity below 60%. A reactive QTF-CMV (IFN-γ ≥0.2 IU/mL) provided good sensitivity (81.6%) and PPV (92.5%), at the expense of a poor specificity (22.2%).</p><p><strong>Conclusions: </strong>The discriminative capacity to predict immune protection against clinically relevant CMV infection among intermediate-risk KT recipients was comparable for ICS and QTF-CMV. A selected ICS threshold may provide better specificity than the interpretative cut-off values currently recommended for QTF-CMV.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14437"},"PeriodicalIF":2.6000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic Performance of Two Different Techniques to Quantify CMV-Specific Cell-Mediated Immunity in Intermediate-Risk Seropositive Kidney Transplant Recipients.\",\"authors\":\"Mario Fernández-Ruiz, Marcos Nuévalos, Isabel Rodríguez-Goncer, Estéfani García-Ríos, Tamara Ruiz-Merlo, Natalia Redondo, Hernando Trujillo, Esther González, Natalia Polanco, José María Caso, Eduardo Aparicio-Minguijón, Francisco López-Medrano, Rafael San Juan, Amado Andrés, Pilar Pérez-Romero, José María Aguado\",\"doi\":\"10.1111/tid.14437\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Kidney transplant (KT) recipients at intermediate risk for cytomegalovirus (CMV) infection constitute a potential target for individualized prevention strategies informed by the CMV-specific cell-mediated immunity (CMV-CMI). The optimal method for the functional assessment of CMV-CMI in this group remains unclear.</p><p><strong>Methods: </strong>We included 74 CMV-seropositive KT recipients that did not receive T-cell-depleting induction and were managed by preemptive therapy. CMV-CMI was monitored at baseline and months 1, 3, 6, and 12 by intracellular cytokine staining (ICS) and a interferon (IFN)-γ-release assay (QuantiFERON-CMV [QTF-CMV]). Both methods were compared for discriminative capacity (areas under the receiving operating characteristic curve [auROCs]) and diagnostic accuracy to predict protection against high-level (≥1000 IU/mL) CMV DNAemia and/or disease.</p><p><strong>Results: </strong>Eighteen patients (24.3%) experienced high-level CMV DNAemia or disease. There were no significant differences in the discriminative capacity to predict protection of CMV-specific CD8+ (auROC: 0.719) and CD4+ T-cell counts (auROC: 0.664) enumerated by ICS and IFN-γ production measured by QTF-CMV (auROC: 0.666). Optimal cutoff values of ≥9.8 CMV-specific CD4+ T-cells/µL and ≥5.7 CD8+ T-cells/µL by ICS yielded excellent specificity (95.7% and 86.9%, respectively) and positive predictive values (PPVs) (>98.0%), but a sensitivity below 60%. A reactive QTF-CMV (IFN-γ ≥0.2 IU/mL) provided good sensitivity (81.6%) and PPV (92.5%), at the expense of a poor specificity (22.2%).</p><p><strong>Conclusions: </strong>The discriminative capacity to predict immune protection against clinically relevant CMV infection among intermediate-risk KT recipients was comparable for ICS and QTF-CMV. A selected ICS threshold may provide better specificity than the interpretative cut-off values currently recommended for QTF-CMV.</p>\",\"PeriodicalId\":23318,\"journal\":{\"name\":\"Transplant Infectious Disease\",\"volume\":\" \",\"pages\":\"e14437\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplant Infectious Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/tid.14437\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplant Infectious Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/tid.14437","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:肾移植(KT)受者巨细胞病毒(CMV)感染的中等风险构成了CMV特异性细胞介导免疫(CMV- cmi)告知个体化预防策略的潜在目标。该组CMV-CMI功能评估的最佳方法尚不清楚。方法:我们纳入74例cmv血清阳性KT受体,未接受t细胞消耗诱导,并采用先发制人治疗。通过细胞内细胞因子染色(ICS)和干扰素(IFN) γ释放试验(QuantiFERON-CMV [QTF-CMV])在基线和1、3、6和12个月监测CMV-CMI。比较两种方法在预测对高水平(≥1000 IU/mL) CMV dna血症和/或疾病的保护作用方面的判别能力(接收工作特征曲线下面积[auroc])和诊断准确性。结果:18例(24.3%)患者出现高水平CMV dna血症或疾病。在预测cmv特异性CD8+ (auROC: 0.719)和CD4+ t细胞计数(auROC: 0.664)和QTF-CMV测量IFN-γ产生(auROC: 0.666)的保护能力方面,ICS和QTF-CMV测量的特异性CD8+和CD4+ t细胞计数(auROC: 0.664)没有显著差异。ICS的最佳临界值为≥9.8 cmv特异性CD4+ t细胞/µL和≥5.7 CD8+ t细胞/µL,特异性为95.7%和86.9%,阳性预测值(ppv)为98.0%,但灵敏度低于60%。反应性QTF-CMV (IFN-γ≥0.2 IU/mL)提供了良好的灵敏度(81.6%)和PPV(92.5%),但特异性较差(22.2%)。结论:ICS和QTF-CMV在预测中等风险KT受体对临床相关CMV感染的免疫保护能力方面具有可比性。选择ICS阈值可能比目前推荐的QTF-CMV解释性临界值提供更好的特异性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Diagnostic Performance of Two Different Techniques to Quantify CMV-Specific Cell-Mediated Immunity in Intermediate-Risk Seropositive Kidney Transplant Recipients.

Background: Kidney transplant (KT) recipients at intermediate risk for cytomegalovirus (CMV) infection constitute a potential target for individualized prevention strategies informed by the CMV-specific cell-mediated immunity (CMV-CMI). The optimal method for the functional assessment of CMV-CMI in this group remains unclear.

Methods: We included 74 CMV-seropositive KT recipients that did not receive T-cell-depleting induction and were managed by preemptive therapy. CMV-CMI was monitored at baseline and months 1, 3, 6, and 12 by intracellular cytokine staining (ICS) and a interferon (IFN)-γ-release assay (QuantiFERON-CMV [QTF-CMV]). Both methods were compared for discriminative capacity (areas under the receiving operating characteristic curve [auROCs]) and diagnostic accuracy to predict protection against high-level (≥1000 IU/mL) CMV DNAemia and/or disease.

Results: Eighteen patients (24.3%) experienced high-level CMV DNAemia or disease. There were no significant differences in the discriminative capacity to predict protection of CMV-specific CD8+ (auROC: 0.719) and CD4+ T-cell counts (auROC: 0.664) enumerated by ICS and IFN-γ production measured by QTF-CMV (auROC: 0.666). Optimal cutoff values of ≥9.8 CMV-specific CD4+ T-cells/µL and ≥5.7 CD8+ T-cells/µL by ICS yielded excellent specificity (95.7% and 86.9%, respectively) and positive predictive values (PPVs) (>98.0%), but a sensitivity below 60%. A reactive QTF-CMV (IFN-γ ≥0.2 IU/mL) provided good sensitivity (81.6%) and PPV (92.5%), at the expense of a poor specificity (22.2%).

Conclusions: The discriminative capacity to predict immune protection against clinically relevant CMV infection among intermediate-risk KT recipients was comparable for ICS and QTF-CMV. A selected ICS threshold may provide better specificity than the interpretative cut-off values currently recommended for QTF-CMV.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Transplant Infectious Disease
Transplant Infectious Disease 医学-传染病学
CiteScore
5.30
自引率
7.70%
发文量
210
审稿时长
4-8 weeks
期刊介绍: Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.
期刊最新文献
Drug-Induced Hypersensitivity Syndrome/Drug Reaction With Eosinophilia and Systemic Symptoms With Reactivation of Human Herpesvirus-6 in a Liver Transplant Recipient. Application of Syndromic Panels for respiratory Tract Infections in Lung Transplantation: A Critical Review on Current Evidence and Future Perspectives. Letter to the Editor: Severe Outcomes of Pneumocystis Pneumonia: A 10-year Retrospective Cohort Study. Real-World Experience With Maribavir for Treatment of Refractory or Resistant Cytomegalovirus Infection in Hematopoietic Cell Transplant Recipients and Hematologic Malignancy Patients. Role of Fiberoptic Bronchoscopy in Decision-Making in the Management of Post-Hematopoietic Stem Cell Transplant Patients Presenting with Pulmonary Infiltrates: A Retrospective Cohort Study.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1