Evaluation of the immune function assay in pediatric living donor liver transplantation

Abstract

The immune function (ImmuKnow) assay is a measure of cell-mediated immunity based on the peripheral CD4+ T cell ATP activity. The efficacy of ImmuKnow in pediatric LDLT is not well documented. The aim of this study was to assess the correlations between the ImmuKnow and the clinical status in pediatric LDLT recipients. A total of 716 blood samples were obtained from 60 pediatric LDLT recipients (one month to 16 yr of age). The recipient's status was classified as follows: stable, infection, or rejection. The ImmuKnow values in the pediatric LDLT recipients with a clinically stable status had a lower immune response (IQR 85-297 ATP ng/mL) than that previously reported in adults. Meanwhile, the ImmuKnow values of the stable patients were not correlated with age. Furthermore, a significant difference was found in the ImmuKnow values between the bacterial or fungal infection and stable groups, but not between the CMV or EBV infection and stable groups. The ImmuKnow levels in the pediatric LDLT were lower than those observed in the adult LDLT. The proposed reference value is between 85 and 297 ATP ng/mL in pediatric LDLT recipients. We conclude that the ImmuKnow assay could be helpful for monitoring pediatric LDLT recipients with bacterial or fungal infections.

Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

“…This is the first two-centered cohort study conducted in PLT recipients using Cylex ATP assay to evaluate the immune status in PLT less than 3 years old, our result show that median Cylex ATP is 269 ng/mL in stable PLT, which is much lower than that in our previous report in adult patients (32,33). Our result is similar to some other reports that children have significantly lower Cylex ATP levels than those detected in adults (16,34).…”

“…Previous studies have proved that high Cylex ATPs are related to inadequate immunosuppression and high risk of rejection (14)(15)(16), while the low values represent excessive immunosuppression and increased risk of infection (17). The immunosuppressive dosage in children is usually much higher than that in adults probably due to a larger graft-recipient weight ratio (GRWR) and immature cytochrome P450 enzyme activity during the first year of life (18,19).…”

Infectious agents after liver transplant: etiology, timeline and patients’ cell-mediated immunity responses

“…Although it is known that the cell-mediated immunity plays a key role in the control of viral replications, the usefulness of the ImmuKnow ® measurements to predict posttransplant viral infections is not clear. In fact, some studies report that low ImmuKnow ® iATP level did not correlate with episodes of future viral infection [22,23], while others were able to find this association [24,25]. Nevertheless, it must be underlined that each study is heterogeneous from the other regarding recipient age, type of solid organ transplant, timing of ImmuKnow ® measurement to event and viruses taken into account.…”

The role of metronomic capecitabine for treatment of recurrent hepatocellular carcinoma after liver transplantation

“…The management of the immunosuppression becomes very important in this setting not much for the introduction of mTOR inhibitors, which have not shown correlation with the post-recurrence survival, but because we need to find a balance between the graft protection and an immune system reactive against potential tumor cells circulating systemically. In this perspective, the development of laboratory assays able to detect the metabolic activity of the immune cells might be a very useful innovation, since often the blood level of the immunosuppressive drug alone cannot reveal the real status of the immune system of the transplanted patient 30 , 31 .…”