Clinical utility of CD4 + function assessment (ViraCor-IBT ImmuKnow test) in lung recipients
Section snippets
Background
Lung transplantation is an accepted treatment for end-stage lung diseases. Nowadays, the main issue is to achieve an acceptable long-term survival after surgery, and the greatest impediment to improve long-term survival is chronic lung allograft dysfunction (CLAD).Recent evidence pointed out that both aspecific (such as infections) and allospecific lung injuries (acute rejection episodes) are significant risk factors for the occurrence of CLAD [1]. According to recent classification, there are
Patients
61 patients who underwent follow-up for lung transplantation between 2010 and 2014 were included in the IMK study. Features of the included patients are shown in Table 1. At our center, during routine lung transplant follow-up visits, patients undergo complete clinical evaluation; blood tests, respiratory function tests, the assessment of serum trough levels of IS drugs and lymphocyte subsets on peripheral blood. IMK assay was performed at 6 month FU, only for the patients who entered the study
Results
Our population included 47 males and 14 females. The mean age at the time of follow-up was 47 years. Underlying diseases were Idiopathic pulmonary fibrosis/NSIP (n = 27), COPD/Emphysema (n = 13), Pulmonary hypertension (n = 6), Cystic fibrosis (n = 5), Bronchiectasis (n = 3), Ebstein's disease/Eisenmenger Syndrome (n = 3), CLAD/RE-Tx (n = 2), Combined pulmonary fibrosis and emphysema (n = 1), and Lymphangioleiomyomatosis (n = 1). 23 patients underwent single lung transplant, 35 patients underwent double lung
Discussion
One of the major challenges in lung transplantation is balancing immunosuppression in order to avoid drug toxicities and complications of over- and under-immunosuppression. During the past years, several clinical trials of the use of IMK have shown that it is able to detect and measure the rate of “over-IS” of CD4 + cells in solid organ transplant patients, such as the kidney, heart, small bowel and pancreas. All these studies demonstrated the promise of IMK in solid-organ transplant recipients,
Acknowledgment
The authors thank Dr. Katherine O'Donohoe for careful revision of the manuscript.
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