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Abstract：
We aimed at constructing a composite score based on Epstein-Barr virus DNAemia (EBVd) and simple clinical and immunological parameters to predict late severe infection (LI) beyond month 6 in solid organ transplantation (SOT) recipients.
Kidney and liver transplant recipients between May 2014 and August 2016 at 4 participating centers were included. Serum immunoglobulins and complement factors, peripheral blood lymphocyte subpopulations, and whole blood EBVd were determined at months 1, 3, and 6. Cox regression analyses were performed to generate a weighted score for the prediction of LI.
Overall, 309 SOT recipients were followed-up for a median of 1000 days from transplant (interquartile range, 822-1124). Late severe infection occurred in 104 patients (33.6%). The CLIV Score consisted of the following variables at month 6: high-level EBVd (>1500 IU/mL) and recurrent infection during the previous months (6 points); recipient age ≥70 years and chronic graft dysfunction (5 points); cytomegalovirus mismatch (4 points); and CD8+ T-cell count <400 cells/μL (2 points). The area under receiver operating characteristics curve was 0.77 (95% confidence interval, 0.71-0.84). The risk of LI at day 1000 was as follows: score 0, 12.6%; score 2-5, 25.5%; score 6-9, 52.7%; score ≥10, 73.5%.
While waiting for further external validation, the CLIV Score based on clinical and immune-virological parameters is potentially useful to stratify the risk of LI after SOT.
Kidney and liver transplant recipients between May 2014 and August 2016 at 4 participating centers were included. Serum immunoglobulins and complement factors, peripheral blood lymphocyte subpopulations, and whole blood EBVd were determined at months 1, 3, and 6. Cox regression analyses were performed to generate a weighted score for the prediction of LI.
Overall, 309 SOT recipients were followed-up for a median of 1000 days from transplant (interquartile range, 822-1124). Late severe infection occurred in 104 patients (33.6%). The CLIV Score consisted of the following variables at month 6: high-level EBVd (>1500 IU/mL) and recurrent infection during the previous months (6 points); recipient age ≥70 years and chronic graft dysfunction (5 points); cytomegalovirus mismatch (4 points); and CD8+ T-cell count <400 cells/μL (2 points). The area under receiver operating characteristics curve was 0.77 (95% confidence interval, 0.71-0.84). The risk of LI at day 1000 was as follows: score 0, 12.6%; score 2-5, 25.5%; score 6-9, 52.7%; score ≥10, 73.5%.
While waiting for further external validation, the CLIV Score based on clinical and immune-virological parameters is potentially useful to stratify the risk of LI after SOT.
摘要：
我们旨在基于EB病毒DNA血症（EBVd）和简单的临床和免疫学参数构建综合评分，以预测实体器官移植（SOT）受者6个月后的晚期严重感染（LI）。
纳入了2014年5月至2016年8月4个参与中心的肾移植和肝移植受者。血清免疫球蛋白和补体因子，外周血淋巴细胞亚群，在第1、3和6个月测定全血EBVd。进行Cox回归分析以产生用于预测LI的加权得分。
总的来说，从移植开始，对309名SOT接受者进行了中位1000天的随访（四分位数范围，822-1124)。晚期严重感染104例(33.6%)。第6个月时的CLIV评分包括以下变量：高水平EBVd（>1500IU/mL）和前几个月的反复感染（6分）；受体年龄≥70岁和慢性移植物功能障碍（5分）；巨细胞病毒错配（4分）；CD8T细胞计数<400个细胞/μL（2分）。受试者工作特征曲线下面积为0.77(95%置信区间,0.71-0.84）。第1000天LI的风险如下：评分0，12.6%；评分2-5，25.5%；评分6-9，52.7%；评分≥10，73.5%。
在等待进一步的外部验证时，基于临床和免疫病毒学参数的CLIV评分可能有助于对SOT后LI的风险进行分层.
纳入了2014年5月至2016年8月4个参与中心的肾移植和肝移植受者。血清免疫球蛋白和补体因子，外周血淋巴细胞亚群，在第1、3和6个月测定全血EBVd。进行Cox回归分析以产生用于预测LI的加权得分。
总的来说，从移植开始，对309名SOT接受者进行了中位1000天的随访（四分位数范围，822-1124)。晚期严重感染104例(33.6%)。第6个月时的CLIV评分包括以下变量：高水平EBVd（>1500IU/mL）和前几个月的反复感染（6分）；受体年龄≥70岁和慢性移植物功能障碍（5分）；巨细胞病毒错配（4分）；CD8T细胞计数<400个细胞/μL（2分）。受试者工作特征曲线下面积为0.77(95%置信区间,0.71-0.84）。第1000天LI的风险如下：评分0，12.6%；评分2-5，25.5%；评分6-9，52.7%；评分≥10，73.5%。
在等待进一步的外部验证时，基于临床和免疫病毒学参数的CLIV评分可能有助于对SOT后LI的风险进行分层.
