Serial ImmuKnow assay in stable kidney transplant recipients

Abstract

ObjectivesThe ImmuKnow assay (cylex Inc., Columbia, MD) has been reported to measure the global immune monitoring tool for organ transplantation recipients. We assess immuKnow ATP values in stable kidney transplant patients.Material and methodsPatients who were kidney transplanted between September 2008 and May 2011 were enrolled in the prospective serial ImmuKnow assay study. The criteria of inclusion were living donor kidney transplantation (KT), no evidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and PRA less than 50%. ImmuKnow assay monitoring was performed at one day before operation, post operative weeks 4, 8, 12, 16, 20, 24, 36 and 52. We excluded patients who had undergone infectious syndrome or rejection episodes during the follow-up period.ResultsAmong 71 patients who were enrolled in prospective serial ImmuKnow assay monitoring, 37 patients were proven to stable KT patients during the follow-up period. Two hundred and twenty-four samples from 37 patients were collected. ImmuKnow value and immunosuppression drug level were compared in post operative weeks 4, 8, 12, 16, 20, 24, 36 and 52. The value of ImmuKnow assay was significantly different depending on the length of time after transplant (p = 0.038). Interestingly, the pre-transplant ImmuKnow values were lower than those of the immediate post-transplant period.ConclusionsThe ImmuKnow value of stable KT recipients is different according to “time after transplant”. Therefore, “time after transplant” should be considered when applying an ImmuKnow assay in clinical practice.

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“…However, our study had the limitations of a retrospective study from a single centre and the employment of single time point measurements, as well as the risk of potential bias and the effects of confounders. More than 75% of our patients underwent the ImmuKnow assay more than 12 months after transplantation, although the value of ImmuKnow assay was significantly different, depending on the length of time after transplantation within 1 year ; whether the functional immune response differs over time in the late phase requires further investigation. A single result cannot be expected to predict the long‐term immune function of the patient.…”

Three decades' analysis of pediatric liver transplantation outcomes reveals limited long‐term improvements

“…have demonstrated the ability to predict acute rejection by markers of recipient T-cell activity. 16,17 Current literature demonstrates the feasibility of minimizing immunosuppression by using tacrolimus only, and some studies even suggest the viability of removing tacrolimus altogether in some patients who may tolerate it. 18,19 Current science technology do not permit us to identify the patients who would reject their allografts if immunosuppression were to be withdrawn, although advancements in detecting genetic signatures that may be indicative of such tolerance have been made.…”

Management considerations in the failing renal allograft

“…This was supported by a study that found that strong suppression of NFAT‐regulated genes by cyclosporine was associated with increased risks of infectious and malignant complications during renal transplant follow‐up . However, whether or not this can be generalized to all stages post‐transplantation is not yet clear …”