Department of Liver Surgery and Liver Transplantation, Renji Hospital, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai 200127, China.
J Dig Dis. 2011 Dec;12(6):467-75. doi: 10.1111/j.1751-2980.2011.00542.x.
Monitoring immune status in transplant recipients is essential for predicting the risk of infections. The aims of the study were to identify the correlation of a low ImmuKnow adenosine triphosphate (ATP) value with the development of invasive fungal infections (IFIs) and whether this is an independent risk factor for IFIs in liver recipients.
We followed up 248 liver recipients who developed 157 infectious episodes. Peripheral CD4(+) T cells were selected freshly for ATP detection. Percentages of T-helper (Th, CD3(+) CD4(+) ) and T-suppressor (Ts, CD3(+) CD8(+) ) lymphocyte subgroups were also examined.
Overall 44 patients (17.7%) were diagnosed as IFIs, of whom 9 (20.5%) died. The average ImmuKnow ATP value in the IFI patients (109 ± 78 ng/mL) was significantly lower than that in common bacterial infections (174 ± 106 ng/mL, P < 0.01) or stable liver recipients (314 ± 132 ng/mL, P < 0.01), while there was no difference in the Th/Ts ratio among each group. Logistic regression analysis showed ImmuKnow ATP value less than 100 ng/mL was an independent risk factor of IFI (OR = 3.44, P = 0.0237). ImmuKnow ATP values had no correlation with lymphocytes or their subgroups, but tended to correlate with the number of neutrophils and total white blood cells.
ImmuKnow assay monitoring has the potential to identify the patients at risk of developing IFI after liver transplantation (LT), which may provide a feasible measure for optimizing liver recipients' immune cellular function after transplantation.
监测移植受者的免疫状态对于预测感染风险至关重要。本研究旨在确定低 ImmuKnow 三磷酸腺苷（ATP）值与侵袭性真菌感染（IFI）的发展之间的相关性，以及这是否是肝移植受者发生 IFI 的独立危险因素。
我们对 248 例发生 157 次感染事件的肝移植受者进行了随访。新鲜选择外周血 CD4(+) T 细胞进行 ATP 检测。还检查了辅助性 T 细胞（Th，CD3(+) CD4(+)）和抑制性 T 细胞（Ts，CD3(+) CD8(+)）淋巴细胞亚群的百分比。
共有 44 例患者（17.7%）被诊断为 IFI，其中 9 例（20.5%）死亡。IFI 患者的平均 ImmuKnow ATP 值（109 ± 78 ng/mL）明显低于普通细菌感染（174 ± 106 ng/mL，P < 0.01）或稳定的肝移植受者（314 ± 132 ng/mL，P < 0.01），而各组之间的 Th/Ts 比值没有差异。Logistic 回归分析显示，ImmuKnow ATP 值小于 100 ng/mL 是 IFI 的独立危险因素（OR=3.44，P=0.0237）。ImmuKnow ATP 值与淋巴细胞或其亚群无相关性，但与中性粒细胞和总白细胞数有一定的相关性。
ImmuKnow 检测具有识别肝移植后发生 IFI 风险患者的潜力，这可能为优化肝移植受者移植后免疫细胞功能提供一种可行的措施。
