BACKGROUND: The manipulation of immunosuppression therapy remains challenging in patients who develop infectious diseases or multiple organ dysfunction after liver transplantation. We evaluated the outcomes of delayed...BACKGROUND: The manipulation of immunosuppression therapy remains challenging in patients who develop infectious diseases or multiple organ dysfunction after liver transplantation. We evaluated the outcomes of delayed introduction of immunosuppression in the patients after liver transplantation under immune monitoring with ImmuKnow assay. METHODS: From March 2009 to February 2014, 225 consecutive liver recipients in our institute were included. The delayed administration of immunosuppressive regimens was attempted in 11 liver recipients with multiple severe comorbidities. RESULTS: The median duration of non-immunosuppression was 12 days (range 5-58). Due to the infectious complications, the serial ImmuKnow assay showed a significantly low ATP level of 64 +/- 35 ng/mL in the early period after transplantation. With the development of comorbidities, the ImmuKnow value significantly increased. However, the acute allograft rejection developed when a continuous distinct elevation of both ATP and glutamyltranspeptidase levels was detected. The average ATP level measured just before the development of acute rejection was 271 +/- 115 ng/mL. CONCLUSIONS: The delayed introduction of immunosuppressive regimens is safe and effective in management of critically ill patients after liver transplantation. The serial ImmuKnow assay could provide a reliable depiction of the dynamics of functional immunity throughout the clinical course of a given patient.展开更多
目的探讨同种异体原位肝移植患者围手术期免疫细胞功能(ImmuKnow值)、T淋巴细胞形态学变化规律及两者之间的关系。方法选择2009年9月至2010年1月28例行同种异体原位肝移植的患者(肝移植组)和20例健康成人(对照组)进行研究。肝移植组于...目的探讨同种异体原位肝移植患者围手术期免疫细胞功能(ImmuKnow值)、T淋巴细胞形态学变化规律及两者之间的关系。方法选择2009年9月至2010年1月28例行同种异体原位肝移植的患者(肝移植组)和20例健康成人(对照组)进行研究。肝移植组于术前及术后第1、3、5、10、15天抽取外周静脉血,对照组入组时采血,进行ImmuKnow检测和T淋巴细胞形态变化指数检测(morphologic change index of T-lymphocyte,TMCI)。结果 Pearson相关分析显示,肝移植组及对照组共188个ImmuKnow值与对应的TMCI之间存在线性相关,(r=0.166,P=0.023)。结论 Immuknow值与TMCI相关,TMCI可作为临床评估患者T淋巴细胞功能的参考指标,结合其他相关检查,可有效指导肝移植受体免疫抑制剂的个体化应用。展开更多
文摘BACKGROUND: The manipulation of immunosuppression therapy remains challenging in patients who develop infectious diseases or multiple organ dysfunction after liver transplantation. We evaluated the outcomes of delayed introduction of immunosuppression in the patients after liver transplantation under immune monitoring with ImmuKnow assay. METHODS: From March 2009 to February 2014, 225 consecutive liver recipients in our institute were included. The delayed administration of immunosuppressive regimens was attempted in 11 liver recipients with multiple severe comorbidities. RESULTS: The median duration of non-immunosuppression was 12 days (range 5-58). Due to the infectious complications, the serial ImmuKnow assay showed a significantly low ATP level of 64 +/- 35 ng/mL in the early period after transplantation. With the development of comorbidities, the ImmuKnow value significantly increased. However, the acute allograft rejection developed when a continuous distinct elevation of both ATP and glutamyltranspeptidase levels was detected. The average ATP level measured just before the development of acute rejection was 271 +/- 115 ng/mL. CONCLUSIONS: The delayed introduction of immunosuppressive regimens is safe and effective in management of critically ill patients after liver transplantation. The serial ImmuKnow assay could provide a reliable depiction of the dynamics of functional immunity throughout the clinical course of a given patient.
文摘目的探讨同种异体原位肝移植患者围手术期免疫细胞功能(ImmuKnow值)、T淋巴细胞形态学变化规律及两者之间的关系。方法选择2009年9月至2010年1月28例行同种异体原位肝移植的患者(肝移植组)和20例健康成人(对照组)进行研究。肝移植组于术前及术后第1、3、5、10、15天抽取外周静脉血,对照组入组时采血,进行ImmuKnow检测和T淋巴细胞形态变化指数检测(morphologic change index of T-lymphocyte,TMCI)。结果 Pearson相关分析显示,肝移植组及对照组共188个ImmuKnow值与对应的TMCI之间存在线性相关,(r=0.166,P=0.023)。结论 Immuknow值与TMCI相关,TMCI可作为临床评估患者T淋巴细胞功能的参考指标,结合其他相关检查,可有效指导肝移植受体免疫抑制剂的个体化应用。
