Introduction: Infection represents a major complication after kidney transplantation (KT). Therapeutic drug monitoring is essentially the only approach for the adjustment of immunosuppression in current practice, with suboptimal results. The implementation of immune monitoring strategies may contribute to minimizing the risk of adverse events attributable to over-immunosuppression without compromising graft outcomes.Areas covered: The present review (based on PubMed/MEDLINE searches from database inception to November 2019) is focused on immune biomarkers with no antigen specificity (non-pathogen-specific), including serum levels of immunoglobulins and complement factors, peripheral blood lymphocyte subpopulations, soluble CD30, intracellular ATP production by stimulated CD4+ T-cells, and other cell-based immune assays. We also summarized recent advances in the use of replication kinetics of latent viruses to assess the functionality of T-cell immunity, with focus on the nonpathogenic anelloviruses. Finally, the composite risk scores reported in the literature are critically discussed.Expert opinion: Notable efforts have been made to develop an enlarging repertoire of immune biomarkers and prediction models, although most of them still lack technical standardization and external validation. Preventive interventions based on these tools (prolongation of prophylaxis, tapering of immunosuppression, or immunoglobulin replacement therapy in hypogammaglobulinemic patients) remain to be defined, ideally in the context of controlled trials.

中文翻译：

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确定肾脏移植受者感染风险的预测工具。

简介：感染代表肾脏移植（KT）后的主要并发症。在目前的实践中，治疗药物监测本质上是调整免疫抑制的唯一方法，效果欠佳。免疫监测策略的实施可能有助于最大程度地降低过度免疫抑制引起的不良事件的风险，而不会损害移植物的结果。研究范围：本综述（基于从数据库开始到2019年11月的PubMed / MEDLINE搜索）专注于免疫生物标志物没有抗原特异性（非病原体特异性），包括血清中的免疫球蛋白和补体因子水平，外周血淋巴细胞亚群，可溶性CD30，受刺激的CD4 + T细胞产生的细胞内ATP产生，以及其他基于细胞的免疫测定。我们还总结了使用潜伏病毒的复制动力学来评估T细胞免疫功能的最新进展，重点是非致病性网膜病毒。最后，对文献中报道的综合风险评分进行了严格讨论。专家意见：尽管大多数仍缺乏技术标准化和外部验证，但为开发扩大免疫生物标记和预测模型的库已做出了显着努力。这些工具的预防性干预措施（延长预防，逐渐减少免疫抑制或对低血糖球蛋白血症患者的免疫球蛋白替代疗法）仍有待确定，理想情况是在对照试验中。重点关注非致病性网膜病毒。最后，对文献中报道的综合风险评分进行了严格讨论。专家意见：尽管大多数仍缺乏技术标准化和外部验证，但为开发扩大免疫生物标记和预测模型的库已做出了显着努力。这些工具的预防性干预措施（延长预防，逐渐减少免疫抑制或免疫球蛋白替代疗法在低血糖球蛋白血症患者中）的定义仍有待确定，最好是在对照试验的背景下进行。重点关注非致病性网膜病毒。最后，对文献中报道的综合风险评分进行了严格讨论。专家意见：尽管大多数仍缺乏技术标准化和外部验证，但为开发扩大免疫生物标记和预测模型的库已做出了显着努力。这些工具的预防性干预措施（延长预防，逐渐减少免疫抑制或对低血糖球蛋白血症患者的免疫球蛋白替代疗法）仍有待确定，理想情况是在对照试验中。尽管其中大多数仍然缺乏技术标准化和外部验证。这些工具的预防性干预措施（延长预防，逐渐减少免疫抑制或对低血糖球蛋白血症患者的免疫球蛋白替代疗法）仍有待确定，理想情况是在对照试验中。尽管其中大多数仍然缺乏技术标准化和外部验证。这些工具的预防性干预措施（延长预防，逐渐减少免疫抑制或对低血糖球蛋白血症患者的免疫球蛋白替代疗法）仍有待确定，理想情况是在对照试验中。