Use of cytokine enzyme-linked immunosorbent spot (ELISPOT) assay as an immune monitoring tool in solid organ transplantation

The development of surrogate markers to predict outcome and guide therapeutic interventions after solid organ transplantation is sorely needed by the transplant community. The cytokine enzyme-linked immunosorbent spot (ELISPOT) assay is one such candidate marker that can accurately detect the frequency and cytokine profile of peripheral alloantigen-reactive T lymphocytes in human allograft recipients at high resolution. Published studies provide strongly suggestive evidence that the frequency of donor-reactive interferon γ ELISPOTs in the the peripheral blood of renal transplant recipients directly correlates with the future risk of acute rejection and chronic graft injury. The assay may additionally have utility for directing minimization of toxic immunosuppressants and identifying patients tolerant to their allografts. It is envisioned that ELISPOT-based immune monitoring, complemented by use of several additional surrogate markers, will ultimately provide clinicians with necessary tools to optimize therapy so as to prolong transplant survival with minimal toxicity.