供体来源的无细胞dna作为心脏移植急性排斥反应的诊断生物标志物：系统回顾和荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews Pub Date : 2025-03-20 DOI:10.1016/j.trre.2025.100916

Shujun Liu, Lixing Wang, Shan Liu, Yinlong Zhao

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引用次数: 0

摘要

背景：心肌内膜活检被广泛认为是检测心脏移植后排斥反应的金标准。然而，手术本身存在心肌组织损伤的风险以及手术期间和手术后的相关并发症。鉴于现有诊断方法的局限性，非侵入性生物标志物至关重要。目的评价供体来源无细胞DNA （dd-cfDNA）检测心脏移植受者AR的诊断价值。方法系统检索PubMed、Embase、Cochrane Library和Web of Science自成立以来至2024年8月1日的文献，以确定评估dd-cfDNA对心脏移植受者AR诊断性能的研究。使用EndNote X9对检索到的研究进行筛选。采用Meta-Disc软件1.4版和STATA/SE 14.0进行meta分析。结果10项研究被纳入meta分析。在95%置信区间（CI）下，患者工作特征曲线下的总灵敏度、特异度和面积分别为65% （95% CI, 61 ~ 68%）、79% （95% CI, 78 ~ 80%）和0.83。结论：血浆dd-cfDNA可作为诊断心脏移植受者急性排斥反应的无创生物标志物。然而，需要进一步研究影响诊断性能的因素并优化临床应用。

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Donor–derived cell–free dna as a diagnostic biomarker for acute rejection in heart transplantation: A systematic review and meta–analysis

Background

Endomyocardial biopsy is widely acknowledged as the gold standard for detecting rejection following heart transplantation. However, the operation itself carries a risk of myocardial tissue damage and associated complications during and after surgery. Given the limitations of existing diagnostic approaches, non-invasive biomarkers are crucial.

Objective

This study assessed the diagnostic utility of donor-derived cell-free DNA (dd-cfDNA) in detecting AR in heart transplant recipients.

Methods

A systematic literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from inception to August 1, 2024, to identify studies evaluating the diagnostic performance of dd-cfDNA for AR in heart transplant recipients. Retrieved studies were screened using EndNote X9. Meta-analysis was performed using Meta-Disc software version 1.4 and STATA/SE 14.0.

Results

Ten studies were included in the meta-analysis. The pooled sensitivity, specificity, and area under the receiver operating characteristic curve with 95 % confidence intervals (CIs) were 65 % (95 % CI, 61–68 %), 79 % (95 % CI, 78–80 %), and 0.83, respectively.

Conclusions

This meta-analysis indicates that plasma dd-cfDNA may serve as a promising non-invasive biomarker for the diagnosis of acute rejection in heart transplant recipients. However, further research is warranted to investigate factors influencing diagnostic performance and optimize clinical utility.

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来源期刊

Transplantation Reviews IMMUNOLOGY-TRANSPLANTATION

CiteScore

7.50

自引率

2.50%

发文量

审稿时长

29 days

期刊介绍： Transplantation Reviews contains state-of-the-art review articles on both clinical and experimental transplantation. The journal features invited articles by authorities in immunology, transplantation medicine and surgery.