1. Plasma immune signatures can predict rejection-free survival in the first year after pediatric liver transplantation.
- Author
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Chichelnitskiy, Evgeny, Goldschmidt, Imeke, Ruhl, Louisa, Rübsamen, Nicole, Jaeger, Veronika K., Karch, Andre, Beushausen, Kerstin, Keil, Jana, Götz, Juliane K., D'Antiga, Lorenzo, Debray, Dominique, Hierro, Loreto, Kelly, Deirdre, McLin, Valerie, Pawlowska, Joanna, Mikolajczyk, Rafael T., Bravi, Michela, Klaudel-Dreszler, Maja, Demir, Zeynep, and Lloyd, Carla
- Subjects
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KILLER cells , *TREATMENT effectiveness , *LIVER transplantation , *BLOOD cells , *TRANSLATIONAL research - Abstract
After pediatric liver transplantation (pLT), children undergo life-long immunosuppression since reliable biomarkers for the assessment of rejection probability are scarce. In the multicenter (n = 7) prospective clinical cohort "ChilSFree" study, we aimed to characterize longitudinal dynamics of soluble and cellular immune mediators during the first year after pLT and identify early biomarkers associated with outcome. Using a Luminex-based multiplex technique paired with flow cytometry, we characterized longitudinal dynamics of soluble immune mediators (SIMs, n = 50) and immune cells in the blood of 244 patients at eight visits over 1 year: before, and 7/14/21/28 days and 3/6/12 months after pLT. The unsupervised clustering of patients based on SIM profiles revealed six unique SIM signatures associated with clinical outcome. From three signatures linked to improved outcome, one was associated with 1-year-long rejection-free survival and stable graft function and was characterized by low levels of pro-inflammatory SIMs (CXCL8/9/10/12, CCL7, SCGF-β, sICAM-1), and high levels of regenerative (SCF, TNF-β) and pro-apoptotic (TRAIL) SIMs (all, p <0.001, fold change >100). Of note, this SIM signature appeared 2 weeks after pLT and remained stable over the entire year, pointing towards its potential as a novel early biomarker for minimizing or weaning immunosuppression. In the blood of these patients, a higher frequency of CD56bright natural killer cells (p <0.01), a known hallmark also associated with operationally tolerant pLT patients, was detected. The concordance of the model for prediction of rejection based on identified SIM signatures was 0.715, and 0.795, in combination with living-related transplantation as a covariate, respectively. SIM blood signatures may enable the non-invasive and early assessment of rejection risks in the first year after pLT, paving the way for improved clinical management. ChilSFree represents the largest pediatric liver transplant (pLT) cohort with paired longitudinal data on soluble immune mediators (SIMs) and immune phenotyping in the first year after pLT. SIM signatures allow for the selection of rejection-free patients 2 weeks after pLT independently of patient diagnosis, sex, or age. The SIM signatures may enable the non-invasive and early assessment of rejection risks, paving the way for minimization or withdrawal of immunosuppression after pLT. [Display omitted] • Early long-term predictive biomarkers for rejection-free survival post-pLT are missing. • Longitudinal SIM and immune phenotyping data up to 1-year post-pLT were acquired. • SIM signatures appearing 2 weeks post-pLT identify rejection-free patients. • SIM signatures can rank rejection risks and may facilitate optimization of immunosuppression. • Early intense immunosuppression may prevent development of favorable SIM signatures. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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