Polymorphonuclear leukocyte functions as predictive markers for infections after organ transplantation
Autor: | Paul Hengster, Marialuise Kunc, G. Egger, Astrid Burda, Raimund Margreiter |
---|---|
Rok vydání: | 2000 |
Předmět: |
Nephrology
Adult Male medicine.medical_specialty Neutrophils medicine.medical_treatment Gastroenterology Communicable Diseases Organ transplantation Neutrophil Activation Sepsis chemistry.chemical_compound Predictive Value of Tests Internal medicine medicine Lung transplantation Humans Aged Immunosuppression Therapy Transplantation Hematology Predictive marker business.industry Neopterin Organ Transplantation Middle Aged medicine.disease Prognosis chemistry Immunology Female business |
Zdroj: | Transplant International. 13:114-121 |
ISSN: | 1432-2277 0934-0874 |
Popis: | Infectious complications are still a major cause of morbidity and mortality after organ transplantation, and early therapy would certainly reduce the risk associated with severe infections. We therefore investigated the significance of polymorphonuclear leukocyte (PMN) functional tests as predictive markers for infection in transplant patients under immunosuppressive therapy in a longitudinal study. In 41 patients, blood PMN migration and reactive oxygen species release, the blood levels of PMN elastase, malondialdehyde, neopterin, sICAM-1 and sVCAM-1, and urine neopterine were measured in 3- and 4-day intervals after liver-, kidney-, kidney-pancreas-, and heart and lung transplantation. PMN migration was determined in whole blood and estimated by the amount of PMNs to penetrate into a membrane filter upon FMLP stimulation. Three groups of patients were formed according to their postoperative course. Group I patients (n = 23) had no or only minor local infection, group II patients (n = 11) had infections with distinct systemic involvement, and group III patients (n = 7) developed sepsis. A first elastase-level of over 100 mg/L after surgery, followed by a drop in the amount of blood PMNs ready to migrate, on FMLP stimulation, to below 12 %, turned out to be a marker for impending infection, whereas all other parameters tested were not predictive. In six of seven group III patients, this marker became positive (sensitivity 85.7 %) up to 15 days before clinical manifestation of sepsis. In group I (largely uneventful recovery) only one of 23 patients was positive (specificity 95.6 % ), whereas group II patients were in between (4 of 11 positive). By this method it seems possible to diagnose severe infections in the pre-clinical phase, which may help prevent them if treatment is begun promptly. |
Databáze: | OpenAIRE |
Externí odkaz: |