T-cell immune monitoring in organ transplantation.
OBJECTIVE
Chronic injury and late allograft loss remain major causes of morbidity in clinical transplantation. Biomarkers that can reliably assess the risk of posttransplant complications are required to direct and individualize therapy aimed at prolonging graft survival and improving patient health. The purpose of this review is to provide a framework for understanding how to use biomarkers in the context of clinical transplantation and to summarize current data on available noninvasive cellular-based immune monitoring methods to predict transplant outcome.


RESULTS
New microarray and gene profiling data reveal peripheral blood cell gene expression patterns that identify operational tolerance, raising the possibility that the measurements can be used to direct immunosuppression withdrawal. Additional data support the use of selective urine gene products and soluble CD30 measurements in serum as reliable biomarkers of acute graft injury. Finally, recent studies demonstrate that measurement of T-cell alloimmunity by cytokine enzyme-linked immunospot is a promising, supplementary pretransplant risk assessment tool.


CONCLUSIONS
Recently published studies in organ transplantation suggest that results derived from assays focused on markers of T-cell immunity can segregate transplant candidates or recipients into high and low-risk subgroups for posttransplant graft injury. Larger prospective studies are needed, however, before any proposed biomarker can be incorporated into the transplant physicians' armamentarium to guide individualized therapeutic decision-making.
Dinavahi
Rajani
R
Mount Sinai School of Medicine, Division of Nephrology Recanati Miller Transplantation Institute, Immunology Institute New York, New York, USA.
Heeger
Peter S
PS
D001681:Biological Assay; D015415:Biomarkers / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D005434:Flow Cytometry; D020869:Gene Expression Profiling / Q000379:methods; D005819:Genetic Markers; D006084:Graft Rejection / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020411:Oligonucleotide Array Sequence Analysis; D016377:Organ Transplantation / Q000009:adverse effects*; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D013601:T-Lymphocytes / Q000276:immunology*; D023001:Transplantation Tolerance
D015415:Biomarkers; D005819:Genetic Markers; D007166:Immunosuppressive Agents