| BackgroundMajor progress was achieved in prolongation of heart recipient survival because of the development of immune suppressing medications. Nevertheless, acute rejection caused by under-IS and infection related to over-IS remain the major factors affecting the short and long prognosis of the heart transplantation. Applying the minimal effective dose of IS therapy has become the trend of mainstream. The major task is how to balance the risk of rejection and the side effects of IS therapy. Currently, monitoring the efficacy and safety of the IS treatment is based on subjective clinical judgment, blood drug levels, echocardiography studies, and endomyocardial biopsies. All these references have their limitations. As the acute rejection are mediated by T lymphocytes and CD4+T lymphocytes play the major role, monitoring the cellular immune function of the recipients is the key to applying an individual IS therapy. ImmuKnowTM technology, approved by U. S. FDA in2002, is currently the most convenient and mature method to assess the immune function of immune suppressed population, and its clinical value has been approved during its application in the foreign organ recipients.ObjectiveTo explore the clinical value of ImmuKnowTM technology in Chinese patients undergoing heart transplantation.MethodWe enrolled twelve patients undergoing heart transplantation in our hospital during2010-12to2011-07. There are10males and2females, their average age is45±11years old. Their primary diseases include dilated cardiomyopathy (n=10), ischemic cardiomyopathy (n=1) and congenital heart disease (n=1). We tested their immune function with ImmuKnowTM technology preoperatively and on the day of3rd,7th and14th days after procedure. Other clinical materials were also recorded, including age, gender, date of operation, primary disease, blood drug level, echocardiography study, results of pathogen examination, lab test, et al. We also enrolled four recipients diagnosed as infection or rejection post-transplantation during2010-12to2011-10. They are all males with average age of41±18years old and with primary disease of dilated cardiomyopathy. Immune function was tested with ImmuKnowTM technology on the day of1st,7th and28th day after admission. Other clinical materials were also recorded respectively. We furthermore enrolled ten stable follow-up recipients during2010-12to2011-10. There are8males and2females. The average age is40±11years old. Their primary diseases include dilated cardiomyopathy (n=10), ischemic cardiomyopathy (n=1) and congenital heart disease (n=1). The immune function was tested with ImmuKnowTM technology on the day of follow-up, and other clinical materials were recorded as well.ResultsThe ImmuKnowTM results of the11survivors preoperatively and on the day of3rd,7th,14th days after heart transplantation was317.23±123.07ng/ml,500.50±301.51ng/ml,513.47±276.44ng/ml、351.59±195.05ng/ml, respectively. The immune function turned down after a week of rising. The peak of immune function presented in the first week after procedure. The level of perioperative recipients’immune function on the14th day after procedure was equal to the level of stable follow-up recipients’immune function. In the perioperative group, there was one death caused by infection and multiple organ dysfunction syndrome (MODS). His ImmuKnowTM result before the death was38.73ng/ml, reflecting the failure of the immune system.The ImmuKnowTM results of the stable follow-up recipients was335.13±123.07ng/ml. All of them showed moderate or low immune function.Dividing all the ImmuKnowTM samples into three groups:stable, infection and acute rejection, the difference between the groups showed statistically significant. The result of ImmuKnowTM test were related to the status of heart recipients, including clinical stable state, infection and acute rejection.Monitoring the immune function of recipients complicated acute/chronic rejection with the ImmuKnowTM technology, the level of the two patients showed a major difference on the day of admission. The patient complicated acute rejection showed a strong immune function of606.23ng/ml while the chronic one showed a moderate immune function of325.92ng/ml. Furthermore, the trend of their immune function under the same corticosteroid impulse therapy were totally different as well. The patient complicated acute rejection showed a downward trend after the corticosteroid impulse therapy with the improvement of clinical status, while the chronic one remained as moderate immune function without obvious improvement of clinical status.Monitoring the immune function of recipients complicated infection with the ImmuKnowTM technology, the level of the two patients showed relatively low immune function on the day of admission. After anti-infective treatment, the immune function of both patients improved and the infection were controlled and cured.Among the total76samples, there were46samples with blood drug level of tarcrolimus. They had no correlation with each other.ConclusionImmuKnowTM technology can evaluate and monitor the immune function of Chinese adult heart recipients effectively. It has important clinical valve and application prospects. The immune function level of Chinese heart recipients has big change in the first two weeks after procedure and since then stabilize at moderate or low level. The range of225to525ng/ml may be the ideal reference range for the Chinese heart recipients. During the treatment of infection or rejection post heart transplantation, the result of ImmuKnowTM test can help the doctor to conclude a diagnosis and guide the treatment. The novelty of this workThis is the first time that ImmuKnowTM technology be used in China to assess the immune function of heart recipients. The change of immune function and its law during the perioperative period were explored. We firstly proposed the reference range of immune function for Chinese heart recipients and tried to apply this technology into guiding the treatment of infection and rejection post heart transplantation. |
PDF Full Text Request