The Assessed Value Of ARP In CD4~T Cells For Immunity Status Of The Liver And Kidney Transplant Recipients

Successful management of the transplant recipient currently required lifelong immunosuppression to avoid graft rejection.While graft survival has been dramatically improved,the patient was at increased risk of drug toxicity,opportunistic infections an cancer.In addition.basal immune reactivity to therapy,surgical trauma,anesthesia and pharmacokinetic differences on drug metabolism had all been demonstrated to influence immunity.so it is necessary to monitor immune status of kidney transplant recipients.In order to accomplish proper immunosuppressant regimen and the balance between immunosuppression insufficiency and overdose,it becomes an important issue in transplant clinical work to assess the globe immune status of kidney transplant recipients.Currently the methods of monitoring immunosuppressive state after organ transplantation includes appraisal of general state.renal function,pathological examination of graft.the concentration of immunosuppressants and immunosuppressive state of recipients.General state of recipients and renal function are not special and the same change can be observed when infection and other complication occurred. Pathological examination of graft is the gold criteria to determine whether ACR presents or not,but it is a traumatic examination and some related complications may occur. The concentration of immunosuppressants is foundation to appraise immunotolerance and adjust clinical medication.However.ACR occurred inevitably in many patients because of individual difference of pharmacokinetics. Lymphocytes count and the proportion of lymphocyte subset are easy and feasible methods to appraise immunosuppressive state.CD4positive lymphocyte plays an important role in ACR after organ transplantation and is target of immunosuppressive therapy.The function of immune cell depends on the ATP supply directly or indirectly,so detection of the concentration of ATP can reflect the function of immunocytes.The purpose of this project is to explore Compared with detection of T lymphocyte subset in peripheral blood and plasma concentrations of CNI, detection of mass concentration of ATP in CD4+T cells in peripheral blood is ability to more accurately in immunity monitoring of liver and renal transplant recipients,and can serve as guidance for adjustment of immunosuppressant’s.Objectives:1. Detection of CD4+T cells ATP volume changes, in order to understand the epidemic status changes for the liver and kidney transplant recipients after surgery, and stable transplant recipients, patients with infection and other state ATP value.2. To better understand cellular immunity changes after transplant recipients in postoperative infection and infection And indicates that infection and other adverse events.3.Detection of mass concentration of ATP in CD4+T cells in peripheral blood is ability to more accurately in immunity monitoring of liver and renal transplant recipients,and can serve as guidance for adjustment of immunosuppressant’s.Methods:①Fifty renal transplant recipients were divided into infection group (with infection, n=13) and control group (without infection, n=37) according to the clinical status,and both groups received immunosuppressive therapy based on Calcineurin inhibitors of cyclosporin and Tacrolimus.②Seventy-five renal transplant recipients were divided into infection group (with infection, n=20) and control group (without infection, n=55) according to the clinical status,and both groups received immunosuppressive therapy based on calcineurin inhibitors of cyclosporin and tacrolimus.③Peripheral blood samples were collected from liver and renal transplant recipients.The mass concentrations of ATP in CD4+T cells in peripheral blood were detected by Immune method, the percentages of T lymphocyte subset of CD3+T cells, CD4+T cells and CD8+T cells and ratio of CD4+T cells to CD8+T cells (CD4+/CD8+) in peripheral blood were determined by flow cytometry, and the plasma mass concentrations of cyclosporin and tacrolimus were measured by homogeneous immunoassay.The correlations of mass concentrations of ATP in CD4+T cells in peripheral blood with the other parameters were analyzed.Results:一、CD4+T cells within the ATP content of the assessment of liver transplant recipients:1.ATP levels in infected and non-infected of liver transplant recipients were (171±40) the ng/ml and (269±31) ng/ml. Healthy population of CD4+T lymphocyte ATP levels was (406±57) ng/ml.95%confidence interval detection and analysis of three sets of data that CD4+T lymphocyte ATP levels were295-517ng/ml,92-248ng/ml and209-330ng/ml.2.The mass concentration of ATP in CD4+T cells in peripheral blood in infection group was significantly lower than that in control group (P<0.05), and the percentages of CD3+T cells and CD8+T cells in infection group were significantly higher than those in control group (P<0.05). There was no significant difference in percentage of CD4+T cells and CD4+/CD8+in peripheral blood and plasma concentrations of cyclosporin and Tacrolimus between two groups (P>0.05)3.Correlation analysis revealed that liver transplant recipients with the mass concentration of ATP in CD4+T cells in peripheral blood was significantly negatively related to the percentage of CD8+T cells in peripheral blood (r=-0.431, P=0.002),and was significantly positively related to CD4+/CD8+(r=0.287, P=0.043).the mass concentration of ATP in CD4+T cells in peripheral blood was no significantly related to the percentage of CD3+T cells (r=0.079, P=0.585)and CD4+T cells(r=-0.071, P=0.622) in peripheral blood, and plasma concentrations of FK506(r=-0.118, P=0.414) and MMF(r=-0.164, P=0.45)二、CD4+T cells within the ATP content of the assessment of renal transplant recipients:1.ATP levels in infected and non-infected of renal transplant recipients were (161±38) the ng/ml and (244±31) ng/ml.95%confidence interval detection and analysis of three sets of data that CD4+T lymphocyte ATP levels were87ng/ml—234ng/ml and184—304ng/ml.2.The mass concentration of ATP in CD4+T cells in peripheral blood in infection group was significantly lower than that in control group (P<0.05), and the percentages of CD3+T cells and CD8+T cells in infection group were significantly higher than those in control group (P<0.05). There was no significant difference in percentage of CD4+T cells and CD4+/CD8+in peripheral blood, and plasma concentrations of cyclosporin and Tacrolimus between two groups (P>0.05)3.Correlation analysis revealed that renal transplant recipients with the mass concentration of ATP in CD4+T cells in peripheral blood was significantly negatively related to the percentage of CD8+T cells in peripheral blood (r=-0.328, P=0.004), and was no significantly related to CD4+/CD8+(r=0.186, P=0.111),the percentage of CD3+T cells (r=0.055, P=0.640)and CD4+T cells(r=0.171, P=0.142) in peripheral blood, and plasma concentrations of FK506(r=0.059, P=0.614) and CSA(r=0.213, P=0.397).Conclusion1.Normal population of CD4+T lymphocytes within the ATP the level was295ng/ml-517ng/ml.Infected and non-infected of liver transplant recipients ATP levels were (171±40,92-248) ng/ml,(269±31,209-330) ng/ml; infected and non-infected of renal transplant recipients ATP levels were (161±38,87-234) ng/ml,(244±31,184-304) ng/ml.2.CD4+T cells within the ATP content testing can determine liver and kidney transplant recipients postoperative infection and non-infectious cellular immune functional status.Compared with detection of T lymphocyte subset in peripheral blood and plasma concentrations of CNI, detection of mass concentration of ATP in CD4+T cells in peripheral blood is more accurate in immunity monitoring of liver and renal transplant recipients,and can serve as guidance for adjustment of immunosuppressants.3.Correlation analysis revealed that liver transplant recipients with the mass concentration of ATP in CD4+T cells in peripheral blood was significantly negatively related to the percentage of CD8+T cells in peripheral blood and was no significantly related to the percentage of CD4+T in peripheral blood, and plasma concentrations of CNI.