Tampa General Medical Group, Tampa, Florida.
LifeLink Transplant Immunology Lab, Tampa, Florida.
Clin Transplant. 2020 Mar;34(3):e13809. doi: 10.1111/ctr.13809. Epub 2020 Feb 20.
Treatment for severe systemic infections in heart transplantation is reduction in immunosuppression while treating the infection. An assay that measures adenosine triphosphate production in activated lymphocytes (ImmuKnow ) objectively monitors cellular immunity of transplant recipients. In this study, we used ImmuKnow to adjust immunosuppression in heart transplant recipients with severe systemic infections.
Heart transplant recipients were followed with ImmuKnow at the time of biopsy and diagnosis of systemic infection. Patients who developed an infection were monitored by ImmuKnow assay with adjustments in immunosuppression based upon the results of the assay. Maintenance immunosuppression was reinstituted when the ImmuKnow increased to >225 ng/mL of ATP.
Two or more ImmuKnow assays were performed in 80 patients. Thirteen patients developed severe systemic infections. ImmuKnow mean value at the time of diagnosis of infection was 109 ± 49.2 ng/mL. Reduction in immunosuppression and treatment of infection resulted in normalization of ImmuKnow level, resolution of infection, and no episodes of rebound rejection.
Heart transplant recipients with severe systemic infections presented with a decreased ImmuKnow , suggesting over immunosuppression. ImmuKnow can be used as an objective measurement in withdrawing immunosuppression in heart transplant recipients with severe systemic infections.
在治疗心脏移植后严重全身感染时，需要减少免疫抑制来治疗感染。一种测量激活淋巴细胞三磷酸腺苷（ATP）产生的检测方法（ImmuKnow）客观地监测移植受者的细胞免疫。在这项研究中，我们使用 ImmuKnow 来调整严重全身感染的心脏移植受者的免疫抑制。
在进行活检和诊断全身感染时，对心脏移植受者进行 ImmuKnow 检测。发生感染的患者通过 ImmuKnow 检测进行监测，并根据检测结果调整免疫抑制。当 ImmuKnow 增加到>225ng/mL 的 ATP 时，恢复维持性免疫抑制。
80 例患者进行了 2 次或更多次 ImmuKnow 检测。13 例患者发生严重全身感染。感染诊断时 ImmuKnow 的平均值为 109±49.2ng/mL。减少免疫抑制和治疗感染导致 ImmuKnow 水平正常化，感染得到解决，并且没有出现反弹排斥反应。
患有严重全身感染的心脏移植受者的 ImmuKnow 降低，表明免疫过度抑制。ImmuKnow 可作为客观指标，用于减少严重全身感染的心脏移植受者的免疫抑制。
