Invasive fungal infection after liver transplantation: risk factors and significance of immune cell function monitoring.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.