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A New Routine Immunity Score (RIS2020) to Predict Severe Infection in Solid-Organ Transplant Recipients

Sarmiento E.; Ezzahouri I.; Jimenez-Lopez M.; Limay Carré K.M.; Alonso R.; Ortiz-Bautista C.; Salcedo Plaza M.; Rodríguez-Ferrero M.L.; Padilla-Machaca P.M.; Cerron A.; Chaman J.C.; Vionnet Salvo A.P.; Carbone J. · Annals of Transplantation (2025) · DOI: 10.12659/aot.946233

Resumen

Background: Infection is a cause of morbidity and mortality in solid-organ transplantation (SOT). We evaluated a new score that is applied during the first month after transplantation. The score comprises biomarkers of innate and acquired immunity to predict infections in SOT. Material/Methods: Prospectively collected blood samples from 377 heart, liver, or kidney recipients were analyzed at 2 centers in Madrid (Spain) and Lima (Peru). Biomarkers were tested before transplantation and at days 7 and 30 after transplantation. During the first 6 months after transplantation, 183 (48.5%) patients developed severe infections (bacterial infections and/or CMV disease). Risk for severe infection was assessed using logistic regression analysis. We designed a score, the routine immunity score (RIS2020), which is based on the sum of the hazard ratios (HRs) of each biomarker. Results: The risk factors for severe infection were as follows: Moderate IgG hypogammaglobulinemia (IgG <600 mg/dL at days 7 or 30, HR 2.07, 95% CI 1.37-3.12, p=0.0005, 2 points), CD4 <400 cells/uL at day 30 (HR 1.76, 95% CI 1.03-3.04, p=0.039, 2 points), C3 <80 mg/dL at day 30 (HR 2.18, 95% CI 1.16-4.06, p=0.014, 2 points), and CRP >3 mg/dL at day 30 (HR 2.11, 95% CI 1.12-3.97, p=0.02, 2 points). In patients with ≥4 points, the HR for infection was 5.18 (95% CI 3.06-8.75; p<0.001). RIS2020 was an independent predictor of severe infection in multivariate models. Conclusions: An immunological score combining moderate IgG hypogammaglobulinemia and other parameters of innate and acquired immunity could better identify the risk for severe infection in SOT. © Ann Transplant, 2025;.