Background: Liver transplantation is a curative method for end-stage liver
diseases, small unresectable hepatocellular carcinoma and acute liver failure. The
discovery of immunosuppressive drugs increases the survival rate of liver
transplanted recipients by reducing the incidence of graft rejection. Several
complications such as renal dysfunction and increase risk of malignancy result
from life-long treatment of transplanted recipients with immunosuppressant. If
recipients are over-immunosuppressed, the risk of infection might be increased.
On the other hands, if recipients are under-immunosuppressed, the risk of
rejection would be increased. It should be useful if a test or a bio-marker that
could predict and differentiate infection and rejection in transplanted recipients.
Therefore, patients could be treated before adverse conditions. Although
therapeutic drug monitoring has been performed as a routine test, it is mainly
targeted for minimizing drug toxicity but little help in predicting infection and
rejection. A new assay named Cylex? Immuknow? assay is designed to measure
global cell mediated immunity of immunosuppressed population, by quantifying
the amount of ATP synthesis by CD4+ T cells in response to PHA stimulation. It is
undergoing evaluation in assessing the immune status of patients in order to
predict the risk of infection and rejection, and also other conditions. (1, 2)
Objectives: In this pilot study, we would like to evaluate ImmuKnow for
predicting the risk of infection and rejection in liver transplanted recipients in
Hong Kong.
Methods: Blood samples were collected from liver transplanted recipients at
different time intervals. The immune cell response of these patients was measured
by Immuknow assay. Patients with low immune response might have a high risk
of infection, patients with high immune response might have a high risk of
rejection, and patients with moderate immune response should be clinically stable.
Results and conclusion: Twenty-six blood samples were collected from eight
transplanted recipients. The average Immuknow assay value for the
post-transplant samples was 304.6 ng/mL ATP which represented moderate
immune cell response according to the interpretation table. (Table 3) This was
reasonable as the subjects were all clinically stable by well-controlled
immunosuppression. The result was consistent with other studies. (1, 3) However,
the association between low immune cell response and infection, and the
association between high immune cell response and graft rejection could not be
investigated as both of these conditions were not found in this pilot study. A larger
study including episodes of infection and rejection should be conducted in order
to evaluate the value of Immuknow assay more completely. / published_or_final_version / Pathology / Master / Master of Medical Sciences
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/174378 |
| Date | January 2011 |
| Creators | 陳旭昇, Chan, Yuk-sing. |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B47318351 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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