Jwa Eunkyoung, Hwang Shin, Kwon Yong-Jae, Kim Nayoung, Song Gi-Won, Jung Dong-Hwan, Ahn Chul-Soo, Tak Eunyoung, Moon Deok-Bog, Kim Ki-Hun, Ha Tae-Yong, Park Gil-Chun, Lee Sung-Gyu
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Hepatobiliary Pancreat Surg. 2015 Nov;19(4):139-48. doi: 10.14701/kjhbps.2015.19.4.139. Epub 2015 Nov 30.
BACKGROUNDS/AIMS: We evaluated the clinical usability of immune cell monitoring in adult liver transplantation (LT) recipients.
This study was composed of two parts as using calcineurin phosphatase (CNP) activity assay and ImmuKnow assay independently as in vitro monitoring tools of immune cell function in adult LT recipients.
There was a rough correlation between CNP activity and tacrolimus concentration in 33 patients. This association was evident in patients who were only administered tacrolimus, but disappeared after the co-administration of mycophenolate. In 118 healthy individuals, the mean proportion of helper T-cells was 37.4±8.1%. According to ImmuKnow assay, their immune responses were strong in 12 patients (10.2%), moderate in 92 patients (78.0%), and low in 14 patients (11.9%). In 85 patients waiting for LT, there was a rough correlation between the ImmuKnow ATP level and age. Their immune responses were strong in 0 patients (0%), moderate in 8 patients (9.4%), and low in 77 patients (90.6%). There was a difference in the ImmuKnow ATP levels between healthy individuals and patients with liver disease. In 137 LT recipients, there was no correlation between the ImmuKnow ATP levels and tacrolimus concentration. This trend did not change after grouping the patients according to co-administration with mycophenolate. Eight recipients experienced acute rejection, but none showed strong immune response.
We think that both CNP activity assay and ImmuKnow assay are too limited to objectively determine the level of immunosuppression. Further studies should be performed to identify other methods for immune function monitoring.
背景/目的：我们评估了免疫细胞监测在成人肝移植受者中的临床实用性。
本研究分为两部分，分别独立使用钙调神经磷酸酶（CNP）活性测定法和免疫状态监测（ImmuKnow）测定法作为成人肝移植受者免疫细胞功能的体外监测工具。
33例患者的CNP活性与他克莫司浓度之间存在大致相关性。这种关联在仅接受他克莫司治疗的患者中明显，但在联合使用霉酚酸酯后消失。在118名健康个体中，辅助性T细胞的平均比例为37.4±8.1%。根据免疫状态监测测定法，12例患者（10.2%）免疫反应强，92例患者（78.0%）免疫反应中等，14例患者（11.9%）免疫反应弱。在85例等待肝移植的患者中，免疫状态监测ATP水平与年龄之间存在大致相关性。0例患者（0%）免疫反应强，8例患者（9.4%）免疫反应中等，77例患者（90.6%）免疫反应弱。健康个体与肝病患者的免疫状态监测ATP水平存在差异。在137例肝移植受者中，免疫状态监测ATP水平与他克莫司浓度之间无相关性。根据是否联合使用霉酚酸酯对患者进行分组后，这一趋势未改变。8例受者发生急性排斥反应，但均未表现出强烈免疫反应。
我们认为CNP活性测定法和免疫状态监测测定法都有局限性，无法客观确定免疫抑制水平。应进行进一步研究以确定其他免疫功能监测方法。
