Monitoring cell-mediated immunity during immunosuppression reduction in heart transplant recipients with severe systemic infections.

Autor: Weston MW; Tampa General Medical Group, Tampa, Florida., Rinde-Hoffman D; Tampa General Medical Group, Tampa, Florida., Lopez-Cepero M; LifeLink Transplant Immunology Lab, Tampa, Florida.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2020 Mar; Vol. 34 (3), pp. e13809. Date of Electronic Publication: 2020 Feb 20.
DOI: 10.1111/ctr.13809
Abstrakt: Background: Treatment for severe systemic infections in heart transplantation is reduction in immunosuppression while treating the infection. An assay that measures adenosine triphosphate production in activated lymphocytes (ImmuKnow ® ) objectively monitors cellular immunity of transplant recipients. In this study, we used ImmuKnow ® to adjust immunosuppression in heart transplant recipients with severe systemic infections.
Methods: Heart transplant recipients were followed with ImmuKnow ® at the time of biopsy and diagnosis of systemic infection. Patients who developed an infection were monitored by ImmuKnow ® assay with adjustments in immunosuppression based upon the results of the assay. Maintenance immunosuppression was reinstituted when the ImmuKnow ® increased to >225 ng/mL of ATP.
Results: Two or more ImmuKnow ® assays were performed in 80 patients. Thirteen patients developed severe systemic infections. ImmuKnow ® mean value at the time of diagnosis of infection was 109 ± 49.2 ng/mL. Reduction in immunosuppression and treatment of infection resulted in normalization of ImmuKnow ® level, resolution of infection, and no episodes of rebound rejection.
Conclusion: Heart transplant recipients with severe systemic infections presented with a decreased ImmuKnow ® , suggesting over immunosuppression. ImmuKnow ® can be used as an objective measurement in withdrawing immunosuppression in heart transplant recipients with severe systemic infections.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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