The Value Of Cylex Immuknow And T Lymphocyte Subsets In Immune Function Monitoring After Renal Transplantation

Objective: To study the changes of ATP content of CD4⁺T lymphocytes wheninfection occur and the ATP content’s correlation with durg concentrations in renaltransplant recipients. By monitoring the changes of T lymphocytes subsets after renaltransplantation, to explore its changes in post-operative infection and rejection, and focuson the changes of regulatory T cells in rejection and its value in induction of immunetolerance.Methods: This study was divided into two parts. In the first part,45renal transplantrecipients and23healthy volunteers were detected ATP content of CD4⁺T lymphocytes byCylex Immuknow method in their peripheral blood. The recipients were divided into noninfection group （n=34） and infection group （n=11） according to their clinical manifestation.The trough concentrations of the FK506and CSA were detected by microparticle enzymeimmunoassay and fluorescence polarization immunoassay respectively. The hs-CRPconcentrations of serum were detected by immunoturbidimetry. To compare the differenc-es of Immuknow value and hs-CRP concentrations in the3groups, and analysis thecorrelation of Immuknow value with durg concentrations in renal transplant recipients. Inthe second part，17recipients accepted renal transplantation were studied. Collecting theirperipheral blood samples before and7d,14d,21d after operation and when infection orrejection occurred, to detect the T lymphocytes subsets and Immuknow values and analysisthe changes of T lymphocytes subsets.Results: The first part:（1） The ATP content of CD4⁺T lymphocytes of healthyvolunteers, non infection group and the infection group were295±73.7ng/ml,335±189ng/ml and212±155ng/ml respectively.（2） The levels of ATP of infection groupwere obviously lower than the healthy volunteers and non infection group. There werestatistical differences （P=0.041, P=0.043）.（3）24recipients were followed up dynamicly.There were4cases whose ATP values were lower than the post-operative average levels in 5infection recipients.（4） The hs-CRP concentrations of infection group were obviouslyhigher than the non infection group. There were statistical differences （P<0.001）.（5） TheATP content of CD4⁺T lymphocytes were no significantly associated with durg troughconcentrations （P>0.05）. The second part:（1） There were13recipients with stable renalfunction in17recipients. Their CD3⁺, CD4⁺, CD8⁺T lymphocyte percentage, CD4⁺Tlymphocyte counting, CD4⁺/CD8⁺, CD4⁺CD25⁺CD127^lowT lymphocyte （regulatory T cells）percentage and counting had not significant changes from pre-operation to7d,14d,21dafter operation. There were not statistical differences （all P>0.05）. The13recipients’average percentage and counting of CD25⁺T lymphocyte after operation were significantlyhigher than that before operation （P<0.01）.（2） In17recipients, infection occurred on2recipients （1case with upper respiratory tract infection,1case with pulmonary infection）.Their CD4⁺T lymphocyte percentage （44.2%,45.2%） were close to the averagepost-operative levels （46.3±9.7%）, but CD4⁺T lymphocyte counting （265个/μL、144个/μL）were significantly lower than the average post-operative levels （847.9±517.7个/μL）.（3）There were2ones with rejection in17recipients. One developed acute rejection. HisCD4⁺CD25⁺CD127^lowT lymphocyte percentage and counting were3.2%and23.3个/μLrespectively; One developed chronic rejection. His CD4⁺CD25⁺CD127^lowT lymphocytepercentage and counting were2.8%and24个/μL respectively. They were all significantlylower than the average post-operative levels6.7±2.2%and115.3±79.6个/μL. TheCD4⁺/CD8⁺of2recipients with rejection were3.2and3.5, which were higher than theaverage post-operative levels （2.0±1.0）.（4） The ATP value measured by Immuknow andCD4⁺T lymphocyte counting were positively correlated （r=0.447, P <0.05）.Conclusions:（1） The low ATP levels of CD4⁺T lymphocytes after renaltransplantation are a risk factor for infection. Cylex Immuknow cell function assay canmake up for the inadequacy of the drug concentration monitoring, reduce the risk ofinfection and guide clinical immuno-suppressive adjustment.（2） The ATP value measuredby Immuknow are positively correlated with CD4⁺T lymphocyte counting, but are nosignificantly associated with durg trough concentrations.（3） After renal transplantation, thepercentage and counting of CD25⁺T lymphocyte in recipients with stable renal function aresignificantly higher than that before transplantation. The CD4⁺T lymphocyte countingdecrease significantly when infection occur. The CD4⁺/CD8⁺is raised and the levels ofregulatory T cells decrease when rejection occur. Therefor, dynamic monitoring T lymphocyte subsets and the ATP levels of CD4⁺T lymphocytes have importantsignificance to the judgement of the recipients’ immune status, predict infection and inducetransplantation immune tolerance.