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Title: | A simple score can identify kidney transplant recipients at high risk of severe infection over the following 2 years. | Authors: | Dendle C. ;Mulley W.R.;Polkinghorne K.R. ;Holdsworth S.R. ;Thursky K.;Stuart R.L. ;Kanellis J.;Gan P.-Y. | Monash Health Department(s): | Infectious Diseases and Clinical Microbiology | Institution: | (Dendle, Polkinghorne, Mulley, Gan, Kanellis, Stuart, Holdsworth) Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia (Dendle, Stuart) Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia (Polkinghorne, Mulley, Kanellis, Holdsworth) Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia (Polkinghorne) Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia (Thursky) National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia | Issue Date: | 13-Jun-2019 | Copyright year: | 2019 | Publisher: | Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com) | Place of publication: | United States | Publication information: | Transplant Infectious Disease. 21 (3) (no pagination), 2019. Article Number: e13076. Date of Publication: June 2019. | Journal: | Transplant Infectious Disease | Abstract: | Background: The aim of this study was to determine whether a composite score of simple immune biomarkers and clinical characteristics could predict severe infections in kidney transplant recipients. Method(s): We conducted a prospective study of 168 stable kidney transplant recipients who underwent measurement of lymphocyte subsets, immunoglobulins, and renal function at baseline and were followed up for 2 years for the development of any severe infections, defined as infection requiring hospitalization. A point score was developed to predict severe infection based on logistic regression analysis of factors in baseline testing. Result(s): Fifty-nine (35%) patients developed severe infection, 36 (21%) had two or more severe infections, and 3 (2%) died of infection. A group of 19 (11%) patients had the highest predicted infectious risk (>60%), as predicted by the score. Predictive variables were mycophenolate use, graft function, CD4+, and natural killer cell number. The level of immunosuppression score had an area under the receiver operating curve of 0.75 (95% CI: 0.67-0.83). Conclusion(s): Our level of immunosuppression score for predicting the development of severe infection over 2 years has sufficient prognostic accuracy for identification of high-risk patients. This data can inform research that examines strategies to reduce the risks of infection.Copyright © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/tid.13076 | PubMed URL: | 30875147 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30875147] | ISSN: | 1398-2273 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/36072 | Type: | Article | Subjects: | *graft recipient herpes simplex encephalitis/di [Diagnosis] herpes zoster/di [Diagnosis] human immunosuppressive treatment *infection risk invasive aspergillosis/di [Diagnosis] kidney function *kidney graft kidney graft rejection/dt [Drug Therapy] kidney graft rejection/pc [Prevention] length of stay lung infection/di [Diagnosis] lymphocyte subpopulation major clinical study male microsporidiosis/di [Diagnosis] middle aged mortality risk natural killer cell nocardiosis/di [Diagnosis] opportunistic infection/di [Diagnosis] Pneumocystis pneumonia/di [Diagnosis] polyomavirus infection/di [Diagnosis] predictive value priority journal prospective study receiver operating characteristic recurrent infection/di [Diagnosis] risk factor *scoring system sensitivity and specificity virus replication azathioprine/dt [Drug Therapy] immunoglobulin A/ec [Endogenous Compound] immunoglobulin G/ec [Endogenous Compound] immunoglobulin M/ec [Endogenous Compound] mammalian target of rapamycin inhibitor/dt [Drug Therapy] acute graft rejection adenovirus infection/di [Diagnosis] adult antibody mediated rejection article B lymphocyte bloodstream infection/di [Diagnosis] CD4 CD8 ratio CD4 lymphocyte count CD8 lymphocyte count cohort analysis cryptococcosis/di [Diagnosis] cytomegalovirus infection/di [Diagnosis] diagnostic accuracy *disease severity end stage renal disease/su [Surgery] Epstein Barr virus infection/di [Diagnosis] estimated glomerular filtration rate female follow up mycophenolic acid/dt [Drug Therapy] prednisolone/dt [Drug Therapy] tacrolimus/dt [Drug Therapy] human cohort analysis cryptococcosis / diagnosis cytomegalovirus infection / diagnosis diagnostic accuracy *disease severity end stage renal disease / surgery Epstein Barr virus infection / diagnosis estimated glomerular filtration rate female follow up *graft recipient herpes simplex encephalitis / diagnosis herpes zoster / diagnosis CD8 lymphocyte count immunosuppressive treatment *infection risk invasive aspergillosis / diagnosis kidney function *kidney graft kidney graft rejection / drug therapy / prevention length of stay lung infection / diagnosis lymphocyte subpopulation major clinical study microsporidiosis / diagnosis middle aged mortality risk natural killer cell nocardiosis / diagnosis opportunistic infection / diagnosis Pneumocystis pneumonia / diagnosis polyomavirus infection / diagnosis predictive value priority journal prospective study receiver operating characteristic recurrent infection / diagnosis risk factor *scoring system sensitivity and specificity virus replication CD4 lymphocyte count CD4 CD8 ratio bloodstream infection / diagnosis B lymphocyte Article antibody mediated rejection adult adenovirus infection / diagnosis acute graft rejection male |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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