Xue Feng, Gao Wei, Qin Tian, Wu Cheng, Luo Yi, Chen Jing, Zhou Tao, Feng Mingxuan, Qiu Bijun, Zhu Jianjun, He Jia, Xia Qiang
Department of Liver Surgery and Liver Transplantation, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Transplant Center, Tianjin First Central Hospital, Tianjin, China.
Transl Pediatr. 2021 Feb;10(2):333-343. doi: 10.21037/tp-20-256.
Limited studies have been performed in assessment of immune status of pediatric liver transplants (PLTs). We conducted this study to evaluate Cylex immune cell function assay in diagnosis of infection and its potential clinical application in Chinese infant PLTs.
In this prospective cohort study, 227 infant PLTs from two medical centers were enrolled, and 216 completed the study. Cylex ATP values were measured before and after liver transplantation (LT) at week 1, 2, 3, 4, 8, 12 and 24 respectively. Accordingly, patients' clinical records, including demographic data, liver function results, tacrolimus dosages and concentrations were collected and analyzed.
One hundred and sixty of 216 PLTs (74.1%) were diagnosed infection based on the parameters including abnormal vital signs, imaging changes, and pathogens detection, while 44 (20.4%) were clinically stable and 12 (5.6%) experienced acute rejection. The median Cylex ATP value in infant PLTs post-surgery reduced significantly in infection group compared to stable group (median, 137 . 269 ng/mL, P<0.001). Receiver operating characteristic (ROC) curve analysis determined that the cut-off value of Cylex ATP was 152 ng/mL in diagnosis of infection [area under the curve (AUC): 0.784, 95% CI: 0.720-0.848]. Meanwhile, Cylex ATP value showed no correlation to tacrolimus dosage, blood concentration, dose-normalized concentration/dose ratio or Kaup index. However, it tended to correlate weakly with the white blood cell (WBC) number (R =0.462, P<0.0001) and lymphocyte counts (R =0.363, P<0.0001).
In this study, we demonstrated that low Cylex ATP represented partly over-immunosuppression and had diagnostic value in infant PLTs with infections, which might assist individualized immunosuppression in PLT patients.
目前关于小儿肝移植（PLT）免疫状态评估的研究有限。我们开展本研究以评估Cylex免疫细胞功能检测在感染诊断中的应用及其在中国婴幼儿PLT中的潜在临床应用价值。
在这项前瞻性队列研究中，纳入了来自两个医疗中心的227例婴幼儿PLT，其中216例完成了研究。分别在肝移植（LT）后第1、2、3、4、8、12和24周测量Cylex ATP值。相应地，收集并分析患者的临床记录，包括人口统计学数据、肝功能结果、他克莫司剂量和浓度。
根据生命体征异常、影像学改变和病原体检测等参数，216例PLT中有160例（74.1%）被诊断为感染，44例（20.4%）临床稳定，12例（5.6%）发生急性排斥反应。与稳定组相比，感染组婴幼儿PLT术后Cylex ATP值中位数显著降低（中位数，137.269 ng/mL，P<0.001）。受试者工作特征（ROC）曲线分析确定，Cylex ATP诊断感染的截断值为152 ng/mL[曲线下面积（AUC）：0.784，95%CI：0.720 - 0.848]。同时，Cylex ATP值与他克莫司剂量、血药浓度、剂量标准化浓度/剂量比或考普指数均无相关性。然而，它与白细胞（WBC）计数（R = 0.462，P<0.0001）和淋巴细胞计数（R = 0.363，P<0.0001）呈弱相关性。
在本研究中，我们证明低Cylex ATP值部分代表免疫抑制过度，对婴幼儿PLT感染具有诊断价值，这可能有助于PLT患者的个体化免疫抑制治疗。
