Use of immune function test in monitoring immunosuppression in liver transplant recipients

Clin Transplant. Nov-Dec 2012;26(6):826-32. doi: 10.1111/j.1399-0012.2012.01632.x. Epub 2012 May 3.

Abstract

Immune function test (Immuknow™) is a measure of cell-mediated immunity based on peripheral CD4+ T cell adenosine triphosphate activity (desired range, 225-525 ng/mL). We evaluated the role of immune function test (IFT) in monitoring and adjustment of immunosuppression in orthotopic liver transplant (OLT) recipients. A total of 289 IFTs were obtained from 171 patients from March 2007 to June 2008. Graft/patient status was classified as stable, serious infection, or malignancy. IFT levels were analyzed with duration of follow-up after OLT, graft/patient status, and the presence of hepatitis C (HCV) infection. The mean age was 54±14 yr, with 62% men. The median follow-up was 65 (2-249) months. Mean IFT levels were significantly lower in patients who were <24 months than in those≥24 months post-OLT (220±19.5 vs. 257±11.3 ng/mL, p=0.03). Clinically stable patients had higher IFT levels than those with serious infection or malignancy (254±11.1 vs. 162.5±23.9, p<0.001). HCV-infected patients had lower IFT levels than uninfected patients (206.7±15.7 vs. 273±12.0 ng/mL, p<0.001). Immunosuppression was reduced in 58 patients with IFT levels<225 ng/mL, and 90% maintained stable graft function after a median follow-up of 22 (1-39) months. IFT may be a useful tool in monitoring and lowering of immunosuppression in long-term OLT recipients.

MeSH terms

  • CD4-Positive T-Lymphocytes / immunology*
  • CD4-Positive T-Lymphocytes / metabolism
  • Female
  • Follow-Up Studies
  • Graft Rejection / immunology*
  • Hepacivirus / immunology
  • Hepatitis C / immunology*
  • Hepatitis C / virology
  • Humans
  • Immunity, Cellular
  • Immunoassay
  • Immunosuppression Therapy*
  • Immunosuppressive Agents / therapeutic use
  • Infections / complications
  • Liver Diseases / surgery*
  • Liver Transplantation / immunology*
  • Liver Transplantation / pathology
  • Male
  • Middle Aged
  • Monitoring, Immunologic*
  • Postoperative Complications
  • Prognosis
  • Risk Factors

Substances

  • Immunosuppressive Agents