PDF(Pubmed)
Abstract：
UNASSIGNED: Anti-Thymocyte Globulin (ATG) is a cornerstone in immune suppression for solid organ transplantation. The treatment is a delicate balance between complications arising from over-immunosuppression such as infections and cancer versus rejection stemming from under-immunosuppression. CD3+ T-lymphocyte measurements are frequently employed for treatment monitoring. However, this analysis is costly and not always accessible. The aim of this study was to investigate whether the total count of lymphocytes could replace CD3+ T-lymphocyte measurements based on data from our transplantation center combined with a review of the literature. The hypothesis was that the total lymphocyte count could serve as a diagnostic surrogate marker for CD3+ T-lymphocytes.
UNASSIGNED: A retrospective cohort study was conducted, including patients who underwent kidney and/or a pancreas transplantation and received ATG as induction therapy or for rejection treatment. The inclusion criterium was that the total lymphocyte count and CD3+ T-lymphocyte measurements were measured simultaneously on the same day. Additionally, PubMed and Embase were searched up to 18/10/2023 for published studies on solid organ transplantation, ATG, T-lymphocytes, lymphocyte count, and monitoring. In the retrospective cohort study, a total of 91 patients transplanted between 2016 and 2023, with 487 samples, were included.
UNASSIGNED: Total lymphocyte counts below 0.3 x 109/L had a high sensitivity (86%) as a surrogate marker of CD3+ T-lymphocytes below 0.05 x 109/L, but the specificity was low (52%) for total lymphocyte counts above 0.3 x 109/L as a surrogate marker for CD3+ T-lymphocytes above 0.05 x 109/L. A review of the literature identified seven studies comparing total lymphocyte counts and CD3+ T-lymphocytes in ATG monitoring. These studies supported the use of a low total lymphocyte count as a surrogate marker for CD3+ T-lymphocytes and an indicator to omit ATG treatment. However, there was no consensus regarding high total lymphocyte counts as an indicator for continued treatment.
UNASSIGNED: Results supports that the total lymphocyte count can be used to omit ATG treatment when below 0.3 x 109/L whereas the CD3+ T-lymphocyte analysis should be reserved for higher total lymphocyte counts to avoid ATG overtreatment.
UNASSIGNED: A retrospective cohort study was conducted, including patients who underwent kidney and/or a pancreas transplantation and received ATG as induction therapy or for rejection treatment. The inclusion criterium was that the total lymphocyte count and CD3+ T-lymphocyte measurements were measured simultaneously on the same day. Additionally, PubMed and Embase were searched up to 18/10/2023 for published studies on solid organ transplantation, ATG, T-lymphocytes, lymphocyte count, and monitoring. In the retrospective cohort study, a total of 91 patients transplanted between 2016 and 2023, with 487 samples, were included.
UNASSIGNED: Total lymphocyte counts below 0.3 x 109/L had a high sensitivity (86%) as a surrogate marker of CD3+ T-lymphocytes below 0.05 x 109/L, but the specificity was low (52%) for total lymphocyte counts above 0.3 x 109/L as a surrogate marker for CD3+ T-lymphocytes above 0.05 x 109/L. A review of the literature identified seven studies comparing total lymphocyte counts and CD3+ T-lymphocytes in ATG monitoring. These studies supported the use of a low total lymphocyte count as a surrogate marker for CD3+ T-lymphocytes and an indicator to omit ATG treatment. However, there was no consensus regarding high total lymphocyte counts as an indicator for continued treatment.
UNASSIGNED: Results supports that the total lymphocyte count can be used to omit ATG treatment when below 0.3 x 109/L whereas the CD3+ T-lymphocyte analysis should be reserved for higher total lymphocyte counts to avoid ATG overtreatment.
摘要：
■抗胸腺细胞球蛋白（ATG）是实体器官移植免疫抑制的基石。治疗是由过度免疫抑制引起的并发症(如感染和癌症)与由免疫抑制不足引起的排斥之间的微妙平衡。CD3+T淋巴细胞测量经常用于治疗监测。然而,这种分析成本很高，而且并不总是容易获得。这项研究的目的是根据我们移植中心的数据并结合文献综述，研究淋巴细胞总数是否可以代替CD3T淋巴细胞的测量。假设是总淋巴细胞计数可以作为CD3T淋巴细胞的诊断替代标记。
■进行了一项回顾性队列研究，包括接受肾脏和/或胰腺移植并接受ATG诱导治疗或排斥治疗的患者.纳入标准是在同一天同时测量总淋巴细胞计数和CD3T淋巴细胞测量值。此外,截至2023年10月18日，PubMed和Embase进行了关于实体器官移植的已发表研究，ATG,T淋巴细胞,淋巴细胞计数,和监测。在回顾性队列研究中，在2016年至2023年期间，共有91名患者移植，487个样本，包括在内。
■低于0.3×109/L的总淋巴细胞计数作为低于0.05×109/L的CD3+T淋巴细胞的替代标记具有很高的敏感性（86%），但总淋巴细胞计数高于0.3×109/L的特异性较低（52%），作为CD3+T淋巴细胞高于0.05×109/L的替代标记。对文献的回顾确定了七项在ATG监测中比较总淋巴细胞计数和CD3T淋巴细胞的研究。这些研究支持使用低总淋巴细胞计数作为CD3+T淋巴细胞的替代标记和省略ATG治疗的指标。然而,对于高总淋巴细胞计数作为继续治疗的指标尚无共识.
■结果支持当低于0.3x109/L时，总淋巴细胞计数可用于省略ATG治疗，而CD3T淋巴细胞分析应保留用于较高的总淋巴细胞计数，以避免ATG过度治疗。
■进行了一项回顾性队列研究，包括接受肾脏和/或胰腺移植并接受ATG诱导治疗或排斥治疗的患者.纳入标准是在同一天同时测量总淋巴细胞计数和CD3T淋巴细胞测量值。此外,截至2023年10月18日，PubMed和Embase进行了关于实体器官移植的已发表研究，ATG,T淋巴细胞,淋巴细胞计数,和监测。在回顾性队列研究中，在2016年至2023年期间，共有91名患者移植，487个样本，包括在内。
■低于0.3×109/L的总淋巴细胞计数作为低于0.05×109/L的CD3+T淋巴细胞的替代标记具有很高的敏感性（86%），但总淋巴细胞计数高于0.3×109/L的特异性较低（52%），作为CD3+T淋巴细胞高于0.05×109/L的替代标记。对文献的回顾确定了七项在ATG监测中比较总淋巴细胞计数和CD3T淋巴细胞的研究。这些研究支持使用低总淋巴细胞计数作为CD3+T淋巴细胞的替代标记和省略ATG治疗的指标。然而,对于高总淋巴细胞计数作为继续治疗的指标尚无共识.
■结果支持当低于0.3x109/L时，总淋巴细胞计数可用于省略ATG治疗，而CD3T淋巴细胞分析应保留用于较高的总淋巴细胞计数，以避免ATG过度治疗。
