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Guido Trezeguet Renatti^1,2, Agostina Arrigone¹, Catalina Costas¹

¹Unit of Innovative Treatments, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

|March 3, 2026

概括

捐赠者衍生的无细胞DNA (dd-cfDNA) 可以帮助识别患有低排斥风险的儿科肝移植患者. 这种生物标志物用于肝功能测试,可以减少不必要的监测活检.

科学领域:

移植医学移植医学
儿科胃肠病学儿科胃肠病学
免疫学免疫学免疫学

背景情况:

监测活检对于检测儿科肝移植接受者的静音移植排斥至关重要.
目前的方法往往导致所有患者的侵入性手术,即使是低风险患者.
识别非侵入性生物标志物可以帮助低风险患者免受不必要的活检.

研究的目的:

评估来自供体的无细胞DNA (dd-cfDNA),以排除儿科肝移植 (LT) 患者的活检证明急性排斥 (BPAR).
评估dd-cfDNA在指导活检决策中的作用,以及肝功能测试 (LFTs).
开发一种临床决策流程,用于识别低风险排斥患者.

主要方法:

一个临床决策过程是使用98个监测和40个原因活检儿科LT患者的数据开发的.
该研究评估了dd-cfDNA在与LFT一起使用时排除BPAR的能力.
对dd-cfDNA建立了1.9%的门,以确定患有低排斥风险的患者.

主要成果:

在60个BPAR事件中,46.7%是亚临床 (subBPAR).
dd-cfDNA区分了亚BPAR和无BPAR病例,敏感度为96.7%,特异性为34.6%.
决策过程中,使用LFT和dd-cfDNA<1.9%,确定了可以避免活检的患者,产生了93.1%的负预测值.

结论:

低dd-cfDNA水平可靠地识别了患有低排斥风险的儿科肝移植患者.
这种生物标志物有助于定制监测活检,减少侵入性手术.
dd-cfDNA,结合LFTs,改善了儿科LT接受者的风险分层.

关键词:

生物标志物生物标志物在临床决策过程中.诊断技术诊断技术诊断技术测试的预测值测试的预测值.监控监督监督监督监督监督监督监督监督监督监督监督监督监督监督监督监督监督

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