Israeli Moshe, Klein Tirza, Sredni Benjamin, Avitzur Yaron, Mor Eitan, Bar-Nathen Nathan, Steinberg Ran, Dinari Gabriel, Shapiro Rivka
Tissue Typing Laboratory, Rabin Medical Center, Petach-Tikva, Israel.
Liver Transpl. 2008 Jun;14(6):893-8. doi: 10.1002/lt.21426.
Lifelong immunosuppression is mandatory for optimal graft and patient survival following liver transplantation. Nevertheless, graft rejection or numerous adverse events associated with overimmunosuppression or underimmunosuppression cannot be completely avoided. The ImmuKnow assay measures cell-mediated immunity and is able to discern between conditions of overimmunosuppression and underimmunosuppression. The aim of this study was to evaluate the ImmuKnow assay in the evaluation of the immune function in pediatric liver transplant recipients and to assess its correlation with the patients' clinical and biochemical status. Eighty-nine whole blood samples were collected from 23 liver transplant recipients that were 1 to 18 years old. The net state of immune function was determined by the quantitative measurement of the intracellular adenosine 5-triphosphate level in CD4+ lymphocytes after phytohemagglutinin stimulation. Comprehensive clinical data were correlated with the ImmuKnow assay results. In 23 of the 28 samples collected during clinical quiescence, ImmuKnow results were correlated with the clinical status, expressing the patient's moderate immune function. However, a correlation between measured therapeutic drug levels and clinical quiescence was found in only 18 of the 28 samples. In 6 patients who suffered from clinical complications, ImmuKnow measurements showed a wide range of deviations, expressing the unstable immunological status of these patients. In conclusion, the ImmuKnow assay correlates with the clinical status of liver-transplanted children. It serves as a reliable and unique parameter of the cellular immune function. We conclude that the ImmuKnow assay, together with existing clinical tools, may allow for the immune monitoring of pediatric liver recipients.
肝移植后，为了实现移植物和患者的最佳存活，终身免疫抑制是必不可少的。然而，移植物排斥反应或与免疫抑制过度或不足相关的众多不良事件仍无法完全避免。免疫状态检测法可测量细胞介导的免疫功能，并能够区分免疫抑制过度和不足的情况。本研究的目的是评估免疫状态检测法在评估小儿肝移植受者免疫功能方面的作用，并评估其与患者临床和生化状态的相关性。从23名年龄在1至18岁的肝移植受者中采集了89份全血样本。通过定量测量植物血凝素刺激后CD4+淋巴细胞内三磷酸腺苷水平来确定免疫功能的净状态。综合临床数据与免疫状态检测法的结果相关联。在临床静止期采集的28份样本中的23份中，免疫状态检测法的结果与临床状态相关，表明患者的免疫功能处于中等水平。然而，在28份样本中，仅18份样本的治疗药物水平测量值与临床静止期相关。在6名出现临床并发症的患者中，免疫状态检测法的测量结果显示出广泛的偏差，表明这些患者的免疫状态不稳定。总之，免疫状态检测法与肝移植儿童的临床状态相关。它是细胞免疫功能的可靠且独特的参数。我们得出结论，免疫状态检测法与现有的临床工具一起，可能有助于对小儿肝移植受者进行免疫监测。
