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P-2.33 The utility of QuantiFERON monitoring based assay in assessing clinical events among kidney transplant recipients

Maisarah Jalalonmuhali, Malaysia

Nephrologist
Department of Medicine
University Malaya Medical Centre

Biography

Dr Maisarah is currently working as a Consultant in Internal Medicine and Nephrology in University Malaya Medical Centre and a Senior Lecturer in the Department of Medicine University of Malaya. She graduated from the University of Malaya in 2006 and subsequently undertook her Internal Medicine and Nephrology speciality training in this very same privileged institution. In September 2015, she passed her Malaysian Nephrology Board Exit Examination as the best candidate and successfully qualified as registered Nephrologist with the National Specialist Register. Despite being heavily involved with clinical services and teachings, she is also actively involved with research activities. Her previous research works have received numerous recognitions in various clinical conferences, among others were third-best poster presentation in International Society of Nephrology (ISN) in conjunction with World Congress of Nephrology 2019 in Melbourne, Australia (ISN Fellow meeting) as well as third best poster presentation in Congress of The Asian Society of Transplantation 2019 in India. Her interest is in renal transplantation and immunology and recently completed a fellowship program in Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital funded by ISN and UMSC Care fund. Apart from that, she has also published her clinical research works in numerous peer-reviewed international medical journals.

Abstract

The utility of QuantiFERON monitoring based assay in assessing clinical events among kidney transplant recipients

Maisarah Jalalonmuhali1, Soo Jin Lim2, Chee Sian Kuan3, Xue Zheng Wong1, Soo Kun Lim1, Kok Peng Ng1.

1Division of Nephrology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia; 2Sunway Medical Centre Velocity, Kuala Lumpur, Malaysia; 3Neogenix Laboratoire Sdn Bhd, Selangor, Malaysia

Background: Immediate post transplantation care is crucial and requires close monitoring. Traditionally, transplant physicians relied on the crude markers such as therapeutic drug monitoring and clinical events to guide in the management of immunosuppression therapy. Quantiferon Monitor (QFM) is an immune based monitoring assay assessing IFN-γ which can be used as an objective marker of net immune function among kidney transplant recipients. Thus, the objective of this study is to look at the IFN-γ level post transplantation in relation to the incidence of Cytomegalovirus (CMV) viraemia, BK viraemia and hospitalisation. 
Methodology: This is a prospective longitudinal study recruited all new kidney transplant recipients at University Malaya Medical Centre. The QFM were performed either at 1-month, 3-month, 6-month or 12-month post kidney transplantation. Based on the manufactured guidelines, IFN-γ (IU/mL) level < 15 IU/mL is low IFN-γ response, 15 – 1000 IU/mL is moderate IFN-γ response and > 1000 IU/mL  is high IFN-γ response to innate and adaptive immune stimulants. CMV polymerase chain reaction (PCR), BKV PCR and protocol biopsy were performed according to standard protocol. Hospital admissions for any source of infection were recorded from the electronic medical report.
Results: A total of 85 patients with 206 samples for QFM were collected at designated interval. The mean IFN-γ level were 44.49 ± 74.07 IU/mL at 1-month, 94.21 ± 141.57 IU/mL at 3-month, 132.47 ± 168.33 IU/mL  at 6-month and 221.52 ± 219.31 IU/mL at 12-month post transplantation. The levels were in increasing manner. This was correlated with the reduction of immunosuppression post transplantation. The incidence of CMV viraemia, BK viraemia and hospitalisation for any source of infection were significantly associated with low IFN-γ.
Conclusion: IFN-γ is a potential marker of net immune function among renal transplant recipients immediate post transplantation. The initial level would be able to serve as guiding tools for further reduction in immunosuppression and ultimately reduce the risk of infection.

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