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Abstract: SA-OR42

Viro-Immunological Monitoring as a Predictor for Complicative Events in the First Year After Kidney Transplantation: The VIRENO Study

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Affeldt, Patrick, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne,, Cologne, Germany
  • Burkert, Katharina, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne,, Cologne, Germany
  • Dieplinger, Georg, Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
  • Holzmann-Littig, Christopher, Department of Nephrology, Klinikum rechts der Isar, Faculty of Medicine, Technical University Munich, Munich, Germany
  • Tuschen, Katharina, Medical Clinic III - Nephrology and Dialysis, St. Vincenz Hospital Paderborn, Paderborn, Germany
  • Kann, Martin, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne,, Cologne, Germany
  • Grundmann, Franziska, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne,, Cologne, Germany
  • Ditt, Vanessa Alexandra, Institute for Clinical Transfusion Medicine, Transplant Center Cologne, Merheim Medical Center, Cologne General Hospital, Cologne, Germany
  • Wilde, Benjamin, Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
  • Renders, Lutz, Department of Nephrology, Klinikum rechts der Isar, Faculty of Medicine, Technical University Munich, Munich, Germany
  • Stippel, Dirk L., Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
  • Kurschat, Christine E., Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne,, Cologne, Germany
  • Di Cristanziano, Veronica, Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
  • Mueller, Roman-Ulrich, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne,, Cologne, Germany

Group or Team Name

  • VIRENO Team
Background

VIRENO is an interdisciplinary, multicenter study aiming at identifying immunological parameters that predict major infectious and immunological adverse events after kidney transplantation (KTX).

Methods

Viro-immunological monitoring of the cohort was performed pre-KTX, 3 weeks and 6 months post-KTX.
To address humoral immunity, anti-polyomavirus BK (BKPyV) and anti-cytomegalovirus (CMV) IgG were assessed in living donor and recipients. Cellular immunity to CMV was investigated by QuantiFERON-CMV (Qiagen) and T-SPOT®CMV by Oxford Immunotec. In addition, Torque Teno Virus (TTV) viremia was surveyed in all recipients. Clinical parameters were recorded for 12 months after transplantation focusing on infection- and rejection-related endpoints. As part of a first ad hoc evaluation, forward selection (Wald) binary logistic regression was used to determine the variables most suitable for predicting major events after transplantation.

Results

In total, 196 patients were followed up for one year after transplantation. Concerning the two primary endpoints, there were 113 infectious events (CMV n= 52, EBV n= 17, BKPyV n= 40, infection with hospitalization n= 59) and 34 immunological events (rejection n= 30, de novo DSA n= 8). A binary logistic regression model was suitable for predicting infectious complications with high sensitivity (87,1%) but low specificity (50,8%). Concerning prediction of immunological events after transplantation, a binary logistic regression model revealed a high sensitivity (91,7 %) and specificity (93,5%)(Table 1).

Conclusion

First results indicate that viro-immunological monitoring is a promising tool to predict infectious and immunological complications after kidney transplantation.

Binary logistic regression models for immunological and infectious events in the first year after kidney Transplantation (KTx)
 Accuracy (%)Sensitivity (%)Specificity (%)clinical parameters includedbaseline viro-immunological monitoring included3 weeks post Tx Viro-immunological
monitoring included
Infectious events71,986,949,1Age*,
Donor Sex*,
preemptive Donation*,
non immunological kidney disease*,
deceased kidney donation,
TTV (plasma),
TTV per MIOsCells Baseline*,
BKPyV IgG,
TTV (plasma and blood),
TTV (urine),
BKPyV IgG,
Immunological events93,191,793,5genetic kidney diseaseELISPOT IE1*,
Donor BKPyV IgG,
ELISPOT positive control,
CMV Quantiferon PBMC*,
ELISPOT IE1*,

Table 1: logistic regression models of infectious and immunological events: unless otherwise stated, all values are receptor values, *p < 0,1