Humoral and cellular immune monitoring might be useful to identify liver transplant recipients at risk for development of infection

Abstract

Orthotopic liver transplantation (OLT) is a successful therapy for patients with end-stage liver disease, and infection remains a significant cause of morbidity and mortality for patients undergoing this procedure. To assess humoral and cellular immunity markers as potential risk factors for development of infection, 46 consecutive liver transplant recipients (hepatitis C virus cirrhosis [n=17], alcoholic liver disease [n=15], hepatocellular carcinoma [n=9], autoimmune hepatitis [n=2], and other [n=3]) performed at a single center were prospectively studied. Maintenance therapy included tacrolimus (n=37) or cyclosporine (n=9) and prednisone. During follow-up, 27 patients had at least 1 episode of infection (58.7%). Pre-OLT immunoglobulin G (IgG) hypergammaglobulinemia (relative risk [RR] 2.78; 95% confidence interval [CI], 1.17-6.60, P=0.02), pre-OLT IgA hypergammaglobulinemia (RR 2.77, CI=1.24-6.19, P=0.012), and pre-OLT C3 hypocomplementemia (RR 3.02, CI=1.21-7.55, P=0.018) were associated with an increased risk for development of infection. Monitoring of Ig and complement levels might help to identify the risk of developing infection in OLT.

Monitoring of Immunoglobulin Levels Identifies Kidney Transplant Recipients at High Risk of Infection

“…The link between HGG and infection had already been established in other types of SOT (5,6,10,26,30), albeit some authors failed to demonstrate a significant association in liver transplant recipients (3,4). Moreover, the direction of the causal association between both events is not necessarily univocal, since infection itself may contribute to dysregulation of the humoral immune response.…”

“…Patients were enrolled at the time of transplantation and followed clinically for at least 1 year, unless they died before. We conventionally divided the posttransplant follow-up period in three intervals: early (first month), intermediate (months [1][2][3][4][5][6] and late (>6 months). Serum samples were collected just before transplantation (T 0 ) and at month 1 (T 1 ) and 6 (T 6 ).…”

“…Considerable effort has been devoted to the identification of biologic or clinical markers that may predict the occurrence of infectious events (1). It has been previously demonstrated the role of cellular immune monitoring in predicting infection after liver transplantation (2,3). Other authors have reported that the monitoring of humoral immunity, as assessed by the quantification of serum immunoglobulin levels at baseline and during the posttransplant period, may be useful in predicting clinical outcomes in liver (3,4), lung (5) and heart (6) transplantation.…”

“…It has been previously demonstrated the role of cellular immune monitoring in predicting infection after liver transplantation (2,3). Other authors have reported that the monitoring of humoral immunity, as assessed by the quantification of serum immunoglobulin levels at baseline and during the posttransplant period, may be useful in predicting clinical outcomes in liver (3,4), lung (5) and heart (6) transplantation. As a result of the deleterious impact of uremia on B cell differentiation and survival, patients with end-stage renal disease (ESRD) suffer from diffuse reduction of various B cell subpopulations, leading to an impaired humoral immune response (7,8).…”

Immune Alterations in Liver Cirrhosis: Its Relationship with Etiology,Child Pugh Stage and Malnutrition

“…The increased levels of IgA, IgG and the decrease in C3 has been seen in cirrhotics in the pre transplant period and has been associated to a higher risk of infection after surgery [43].…”