Expression Of Human Leukocyte Antigen-DR On Peripheral Mononuclear Cells The Earlier Phase After Liver Transplantation

Objectives:To investigate the expression of HLA-DR on peripheral mononuclear cells in the patients receiving liver transplantation and large dose of immunosuppressants during the early phase post-operation.Study the tendency of HLA-DR expression and its relation to infection and acute rejection.Methods:Twenty-five patients diagnosed as end stage liver disease received orthotopic liver transplantation(OLT)from Jan.2007 to Mar.2007 in Tianjin First central hospital.Among them there were 19 males and 6 females,ranging from 35 to 63 years old.Their primary diagnoses included 17 cases of HBV-related liver cirrhosis, 3 cases of HCV-related liver cirrhosis,4 cases of HBV-related liver cirrhosis combined with hepatic cellular carcinoma and 1 case of alcoholic cirrhosis.All the patients were graded as Child-Pugh C with indication for liver transplantation,and showed no contraindication to OLT.All the recipients received sequential immunosuppressive therapy,prophylactic anti-infection treatment,support treatment for the liver graft arid nutrition.Peripheral venous blood was taken at 24 hours after OLT,on the 3^rd,7^thand the 14^thday after OLT to detect HLA-DR expression positive cells by Flow Cytometry(FCM)for all the patients.At the same time their conditions of infection(mild or severe),acute rejection and prognosis were recorded. Wilcoxon rank sum test was used for statistic analysis by SPSS11.5,with p＜0.05 deemed as difference significant.Receiver Operating Characteristic(ROC)curve was used to analyze the value of HLA-DR expression in prognosticating infection or acute rejection for patient during the early phase post liver transplantation.Results:The median of HLA-DR expression on peripheral mononuclear cells was 38.74 (35.92,39.8)%in the healthy control group.The expression of liver transplant recipient group at different time(24 hours after OLT,on the 3^rd,7^thand the 14^thday after OLT)was decreased obviously than the healthy group,and the difference showed statistic significance(p=0.000).The expression of HLA-DR among the different time after liver transplantation,but the difference between different time showed no statistic significance(p=0.05～0.429).Infection was found in 16 cases,19 episodes within the first 30 days after OLT.Among them 2 cases happened within the first week,8 episodes happened between 7 to 14 days,and 9 episodes happened between 14 to 30 days after OLT.7 cases showed mild infection,but 12 episodes were severe infection among which 4 cases died of multiple organ dysfunction syndrome(MODS)induced by severe infection.Only one case in all the recipients suffered acute rejection during the first month after OLT.The difference of HLA-DR expression between infection group and no-infection group at different time showed no statistic significance(p=0.076～0.380).The difference among no-infection group, mild infection group and severe infection group at different time also showed no statistic significance(p=0.051～0.697),but the difference of minimal HLA-DR expression among these groups showed statistic significance(p=0.039).There was no significant difference between no-infection group and mild infection group at different time(p=0.235～0.500).But the difference of HLA-DR expression between no-infection group and severe infection group during the first week showed statistic significance(p=0.002～0.034).And the difference between mild infection group,and severe infection group during the first week also showed statistic significance (p=0.027).The difference of HLA-DR expression between survival group and dead group at different time showed no statistic significance(p=0.205～0.486).Only 1 recipient suffered acute rejection during the first month after OLT,so I made no statistic analysis.Conclusions:The HLA-DR expression on peripheral mononuclear cells in liver transplant recipients decreased obviously than the healthy group.The expression of HLA-DR showed no obvious change with the liver graft function recovered.The patients suffered severe infection during the early phase after OLT showed significant decrease in expression of HLA-DR.The decrease of HLA-DR expression had no predict effect on the chance of infection/severe infection during the early phase after liver transplantation.Only 1 recipient suffered acute rejection during the first month after OLT,which was too less to analyze statistically.