# A 29-mRNA host-response classifier identifies bacterial infections following liver transplantation – a pilot study

## TL;DR

A 29-mRNA test called IMX-BVN-3b can detect bacterial infections in liver transplant patients earlier than traditional blood markers like CRP and PCT.

## Contribution

The study introduces a new 29-mRNA classifier for early detection of bacterial infections after liver transplantation.

## Key findings

- The IMX-BVN-3b classifier detected bacterial infections in 9 out of 10 patients.
- CRP levels were higher in patients with bacterial infections compared to PCT.
- The classifier showed increased bacterial scores immediately after transplantation, which decreased by day four.

## Abstract

Infections are common complications in patients following liver transplantation (LTX). The early diagnosis and prognosis of these infections is an unmet medical need even when using routine biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT). Therefore, new approaches are necessary.

In a prospective, observational pilot study, we monitored 30 consecutive patients daily between days 0 and 13 following LTX using the 29-mRNA host classifier IMX-BVN-3b that determine the likelihood of bacterial infections and viral infections. True infection status was determined using clinical adjudication. Results were compared to the accuracy of CRP and PCT for patients with and without bacterial infection due to clinical adjudication.

Clinical adjudication confirmed bacterial infections in 10 and fungal infections in 2 patients. 20 patients stayed non-infected until day 13 post-LTX. IMX-BVN-3b bacterial scores were increased directly following LTX and decreased until day four in all patients. Bacterial IMX-BVN-3b scores detected bacterial infections in 9 out of 10 patients. PCT concentrations did not differ between patients with or without bacterial, whereas CRP was elevated in all patients with significantly higher levels in patients with bacterial infections.

The 29-mRNA host classifier IMX-BVN-3b identified bacterial infections in post-LTX patients and did so earlier than routine biomarkers. While our pilot study holds promise future studies will determine whether these classifiers may help to identify post-LTX infections earlier and improve patient management.

German Clinical Trials Register: DRKS00023236, Registered 07 October 2020, https://drks.de/search/en/trial/DRKS00023236

The online version contains supplementary material available at 10.1007/s00423-024-03373-1.