The Monitoring Role Of Lymphocyte Subsets In The Rejection Of Liver Transplantation

BackgroundLiver transplantation is the most effective method of treatment of end-stage liver disease. The postoperative immune rejection affects long-term survival of patients. Rejection treatment is dependent of multiple immunosuppressive drugs. Because the relative gap between its therapeutic concentration and toxic concentration is smaller, timely detection of drug concentration and rejection is very important. Lymphocyte-mediated rejection in liver transplantation rejection occupies an important position. However, lymphocyte subsets in allograft rejection are few researched, the results are not the same, and the changes and roles in clinical liver transplantation are not clear.ObjectiveThis study by analysis of peripheral blood leukocytes change my hospital liver transplant recipients, to explore the relationship of lymphocyte subsets and rejection, and to provide a basis for monitoring rejection, immunosuppressive therapy to provide a theoretical basis.MethodsThe clinical data of patients underwent liver transplant in the People’s Hospital of Zhengzhou from January2011to March2013was analyzed. The12patients with rejection were as research group, and randomly selected26patients without rejection as the control group. The donor acquisition was by fast multi-organ procurement and was stored in UW liquid. The17cases were underwent piggyback liver transplantation with21recipients of Classic liver transplantation. Postoperative tacrolimus (FK506), mycophenolate sodium (Mi Fu, MPA) and prednisone (Pre) triple immunosuppressive therapy was used, as well as anti-infection treatment with cefpirome and teicoplanin. Flow cytometry was used to analyze the changes in peripheral blood T cell subsets, NK cells, and B cells. CD45, CD3, CD4, or CD8were used to distinguished lymphocytes, T cells, CD4, or CD8T cells, respectively; NK and B cells were separated by with CD16+CD56and CD19. Liver tissue was dyed by HE staining:fixed in formalin, embedded dewaxing, staining, dehydration, transparent and were mounted, using Olympus PM-6microscope photography. Diagnosis of acute rejection was established by Banff criteria. Data are expressed as mean±standard error (x±SE), groups were compared using the SSPS17.0package, and P<0.05was considered significant.Results(1) Rejection was occurred in12patients within3weeks after liver transplantation, of them, mild to moderate rejection in5patients and severe rejection in7patients.(2) The warm ischemia time, no liver receptor operative time, infection rates, and FK506trough levels were not significant difference between stable group and rejection group (P>0.05).(3) In stable group, ALT and AST were postoperative rapidly increased, decreased gradually and reverted to near normal, while ALP and GGT was stable after surgery, with getting elevated bilirubin within a week after liver transplantation and gradually reducing after a week later. In rejection group, transaminase and bilirubin were increased again within3weeks after liver transplantation, with a significant difference compared with the stable group (P <0.05).(4) The changes of leukocytes were no significant difference between stable group and rejection group at each time point within3weeks after liver transplantation (P>0.05).(5) exclusion of CD4cells in the T cells was significantly higher than the non-rejection group (P<0.05), The CD4cells and CD4/CD8ratio were significantly higher in rejection group than stable group at corresponding time point within3weeks after liver transplantation (P<0.05).(6) The proportion of NK and B cells was no significant difference between rejection group and stable group after liver transplantation (P>0.05).(7) After liver transplantation, the white blood cells, neutrophils and eosinophils count was no significant difference between rejection group and stable group (P>0.05), but the total number of lymphocytes were higher in rejection group than stable group (P<0.05).Conclusions(1) The peripheral blood lymphocytes and CD4cell ratio are increased in patients with rejection and can be as effective monitoring indicators within3weeks after liver transplant.(2) When the CD4/CD8ratio rises to2.61, the rejection may occur within3weeks after liver transplantation.