Piloni Davide, Magni Sara, Oggionni Tiberio, Benazzo Alberto, Stella Giulia, Scudeller Luigia, Morosini Monica, Cova Emanuela, Meloni Federica
Department of Internal Medicine, PhD in Experimental Medicine, University of Pavia, Pavia, Italy.
Cardiothoracic and Vascular Department, Pneumology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Transpl Immunol. 2016 Jul;37:35-39. doi: 10.1016/j.trim.2016.04.001. Epub 2016 Apr 16.
The ImmuKnow assay measures cell-mediated immunity, quantifying ATP production from peripheral blood CD4+T-cells in solid-organ transplant patients who undergo immunosuppressive therapy. We aimed to measure functional immunity in lung transplant recipients and correlate Immuknow values with immunosuppression levels, presence of chronic lung allograft dysfunction (CLAD) and infections. We evaluated 61 lung recipients who underwent follow-up for lung transplantation between 2010 and 2014. Rejection and infection were retrospectively analyzed. The association between over-immunosuppression and a number of predictors was assessed by means of univariate and multivariate logistic regression models. 71 out of 127 samples (56%) showed an over-immunosuppression with an ImmuKnow assay mean level of 112.92ng/ml (SD±58.2), vs. 406.14ng/ml (SD±167.7) of the rest of our cohort. In the over-immunosuppression group we found 51 episodes of infection (71%) (OR 2.754, 95% CI 1.40-5.39; P-value 0.003). In the other group, only 25 samples (44%) were taken during an infectious episode. The mean absolute ATP level was significantly different between patients with or without infection (202.38±139.06ng/ml vs. 315.51±221.60ng/ml; P<0.001). RAS (Restrictive allograft syndrome) was associated to low ImmuKnow level (P<0.001). These results were confirmed by the multivariate analysis. The ImmuKnow assay levels were significantly lower in infected lung transplant recipients compared with non-infected recipients and in RAS patients.
免疫状态检测（ImmuKnow检测）可测量细胞介导的免疫功能，通过对接受免疫抑制治疗的实体器官移植患者外周血CD4+T细胞产生的三磷酸腺苷（ATP）进行定量分析。我们旨在测量肺移植受者的功能性免疫，并将免疫状态检测值与免疫抑制水平、慢性肺移植功能障碍（CLAD）的存在情况以及感染情况相关联。我们评估了2010年至2014年间接受肺移植随访的61例肺移植受者。对排斥反应和感染情况进行了回顾性分析。通过单因素和多因素逻辑回归模型评估免疫抑制过度与多个预测因素之间的关联。127个样本中有71个（56%）显示免疫抑制过度，免疫状态检测的平均水平为112.92ng/ml（标准差±58.2），而我们队列中的其他样本平均水平为406.14ng/ml（标准差±167.7）。在免疫抑制过度组中，我们发现51例感染事件（71%）（比值比2.754，95%置信区间1.40 - 5.39；P值0.003）。在另一组中，只有25个样本（44%）是在感染事件期间采集的。有感染和无感染患者之间的平均绝对ATP水平存在显著差异（202.38±139.06ng/ml对315.51±221.60ng/ml；P<0.001）。限制性移植综合征（RAS）与免疫状态检测水平低相关（P<0.001）。多因素分析证实了这些结果。与未感染的肺移植受者以及非RAS患者相比，感染的肺移植受者的免疫状态检测水平显著更低。
