Sampson Valerie B, Dunn Stephen P, Rymeski Beth, Malatack James, Rong Nancy H, Flynn Louise, Krueger Leslie J
Nemours Biomedical Research, Molecular Genetics, Cellular and Tissue Transplantation, Wilmington, DE 19803, USA.
J Pediatr Surg. 2008 Jun;43(6):1134-41. doi: 10.1016/j.jpedsurg.2008.02.044.
In children, therapeutic management of immunosuppression relies on allograft function, drug levels, and clinical insight. Using a Food and Drug Administration-approved test for T-cell response, T-cell activation in vitro can be measured to monitor the immune response.
In a retrospective study, 92 posttransplant children who received either a liver and/or kidney transplant and were followed by routine screening had their T-cell response tested by the Cylex ImmuKnow assay (Columbia, MD). After phytohemagglutinin-L stimulation of T-cells, adenosine triphosphate (ATP) concentrations were measured. In this assay, light emission at lambda = 562 nm is proportional to the ATP concentration (ng/mL). Immunosuppressive drug trough levels were also measured. Quantitative real-time polymerase chain reaction Epstein-Barr virus (EBV) viral titers were determined for 2 patients.
Separating the results into younger than 12 years and 12-year or older populations, we found that for the younger than 12 years, 28% of patients were in the low immune function category, 47% in the moderate, and 25% in the high category. For the 12 years or older, 25% of patients were in the low immune function category, 47% in the moderate, and 28% in the high category. The immune function distribution was not different (P = not significant) between the younger than 12 years and 12-year or older groups. Tacrolimus trough levels were 6.3 +/- 2.4 ng/mL for younger than 12 years and 5.6 +/- 3.3 ng/mL for 12 years or older (P = not significant), and rapamycin was similar, but both showed no correlation to immune function. We observed increased ATP values with decreased EBV viral loads.
These results suggest that tacrolimus and/or rapamycin levels do not adequately determine the biologic effect of immunosuppression. We expect that future T-cell activation monitoring will allow us to diminish rejection and infection events posttransplantation and lead to a healthier pediatric transplant population.
在儿童中，免疫抑制的治疗管理依赖于移植器官功能、药物水平和临床洞察力。使用美国食品药品监督管理局批准的检测T细胞反应的方法，可以测量体外T细胞活化以监测免疫反应。
在一项回顾性研究中，对92名接受肝脏和/或肾脏移植并接受常规筛查的移植后儿童，通过Cylex ImmuKnow检测法（马里兰州哥伦比亚）检测其T细胞反应。在用植物血凝素-L刺激T细胞后，测量三磷酸腺苷（ATP）浓度。在该检测中，λ=562nm处的发光与ATP浓度（ng/mL）成正比。还测量了免疫抑制药物的谷浓度。对2例患者测定了定量实时聚合酶链反应爱泼斯坦-巴尔病毒（EBV）病毒滴度。
将结果分为12岁以下和12岁及以上人群，我们发现12岁以下患者中，28%属于低免疫功能类别，47%属于中等免疫功能类别，25%属于高免疫功能类别。12岁及以上患者中，25%属于低免疫功能类别，47%属于中等免疫功能类别，28%属于高免疫功能类别。12岁以下和12岁及以上组之间的免疫功能分布无差异（P=无显著性）。12岁以下患者的他克莫司谷浓度为6.3±2.4 ng/mL，12岁及以上患者为5.6±
