在接受OKT3诱导治疗的肝移植患者中，早期排斥反应风险增加与肝移植后CD3细胞计数的恢复相关。

Increased risk of early rejection correlates with recovery of CD3 cell count after liver transplant in patients receiving OKT3 induction.

作者信息

Sheiner P A, Guarrera J V, Grunstein E, Emre S, Guy S R, Schwartz M E, Miller C M, Boros P

机构信息

Division of Abdominal Organ Transplantation, The Mount Sinai Medical Center, New York, New York 10029, USA.

出版信息

Transplantation. 1997 Oct 27;64(8):1214-6. doi: 10.1097/00007890-199710270-00026.

DOI:10.1097/00007890-199710270-00026

PMID:9355846

Abstract

BACKGROUND

We evaluated the utility of CD3 cell counts for monitoring OKT3 induction immunosuppression and for predicting early rejection in liver recipients.

METHODS

In 32 adults in whom OKT3 and steroids were used to induce immunosuppression, CD3 cell subsets were labeled with CD3 (IgG1)-fluorescein isothiocyanate monoclonal antibody and assayed by flow cytometry before orthotopic liver transplantation and within 2-4 days, 5-7 days, and 8-10 days after transplantation. Trough OKT3 levels were measured at the same points in 10 patients. Early rejection (before postoperative [POD] day 21) was proven by elevated liver function tests and biopsy. Six patients were excluded for death, retransplantation, or early cessation of OKT3.

RESULTS

Eight of 26 patients (30.8%) had early rejection and 18 (69.2%) had no early rejection. All had depletion of CD3 cells to <10.2% of baseline at POD 2-4. On POD 8-10, the mean CD3 count in rejectors was 213.31+/-184.98/mm3 vs. 22.71+/-32.42/mm3 in nonrejectors (P<0.001). By POD 8-10, five of eight (62.5%) patients who rejected had CD3 count recovery to >75% of baseline. No nonrejecting patient recovered to >26% of baseline (P<0.001). OKT3 levels did not correlate with CD3 recovery or rejection.

CONCLUSIONS

The incidence of early rejection correlates strongly with recovery of CD3 counts by POD 10. Higher baseline CD3 counts do not predict early rejection.

摘要

背景

我们评估了CD3细胞计数在监测OKT3诱导的免疫抑制以及预测肝移植受者早期排斥反应方面的效用。

方法

在32例使用OKT3和类固醇诱导免疫抑制的成人患者中，在原位肝移植术前以及移植后2 - 4天、5 - 7天和8 - 10天，用CD3（IgG1）-异硫氰酸荧光素单克隆抗体标记CD3细胞亚群，并通过流式细胞术进行检测。在10例患者的相同时间点测量OKT3谷值水平。通过肝功能检查升高和活检证实早期排斥反应（术后[POD]第21天之前）。6例患者因死亡、再次移植或早期停用OKT3而被排除。

结果

26例患者中有8例（30.8%）发生早期排斥反应，18例（69.2%）未发生早期排斥反应。所有患者在POD 2 - 4时CD3细胞均耗竭至低于基线的10.2%。在POD 8 - 10时，发生排斥反应者的平均CD3计数为213.31±184.98/mm³，未发生排斥反应者为22.71±32.42/mm³（P<0.001）。到POD 8 - 10时，8例发生排斥反应的患者中有5例（62.5%）CD3计数恢复至基线的>75%。没有未发生排斥反应的患者恢复至基线的>26%（P<0.001）。OKT3水平与CD3恢复或排斥反应无关。