Immune cell function assays in the diagnosis of infection in pediatric liver transplantation: an open-labeled, two center prospective cohort study

Abstract

Background: Limited studies have been performed in assessment of immune status of pediatric liver transplants (PLTs). We conducted this study to evaluate Cylex immune cell function assay in diagnosis of infection and its potential clinical application in Chinese infant PLTs. Methods:In this prospective cohort study, 227 infant PLTs from two medical centers were enrolled, and 216 completed the study. Cylex ATP values were measured before and after liver transplantation (LT) at week 1, 2, 3, 4, 8, 12 and 24 respectively. Accordingly, patients' clinical records, including demographic data, liver function results, tacrolimus dosages and concentrations were collected and analyzed.Results: One hundred and sixty of 216 PLTs (74.1%) were diagnosed infection based on the parameters including abnormal vital signs, imaging changes, and pathogens detection, while 44 (20.4%) were clinically stable and 12 (5.6%) experienced acute rejection. The median Cylex ATP value in infant PLTs post-surgery reduced significantly in infection group compared to stable group (median, 137 vs. 269 ng/mL, P<0.001).Receiver operating characteristic (ROC) curve analysis determined that the cut-off value of Cylex ATP was 152 ng/mL in diagnosis of infection [area under the curve (AUC): 0.784, 95% CI: 0.720-0.848]. Meanwhile, Cylex ATP value showed no correlation to tacrolimus dosage, blood concentration, dose-normalized concentration/dose ratio or Kaup index. However, it tended to correlate weakly with the white blood cell (WBC) number (R =0.462, P<0.0001) and lymphocyte counts (R =0.363, P<0.0001). Conclusions:In this study, we demonstrated that low Cylex ATP represented partly overimmunosuppression and had diagnostic value in infant PLTs with infections, which might assist individualized immunosuppression in PLT patients.

Association between intracellular adenosine triphosphate content of CD4+ T lymphocytes and mortality in sepsis patients: A prospective observational study

“…Our study revealed a significant correlation between CD4 + iATP concentration and the counts of white blood cells and neutrophils in sepsis patients, consistent with the findings reported by Naderi et al 26 , 41 However, a previous study indicated no association between iATP levels and white blood cell counts. 32 Therefore, further research is needed to determine whether CD4+ iATP levels can effectively reflect systemic inflammation and innate immune responses.…”

“…Our study, along with other relevant reports, supports the notion that monitoring the concentrations of iATP produced by CD4 + T cells could be valuable in distinguishing between hypoimmune and hyperimmune states. 26 This approach may aid in identifying patients at risk of infection or death, adjusting immunosuppressive agents according to CD4 + iATP content can help reduce mortality and infection in transplant patients, ultimately enhancing the effectiveness of immunotherapy interventions. By assessing CD4 + iATP levels, clinicians may be able to stratify patients and tailor immunomodulatory treatments accordingly, optimizing their response to therapy.…”

“…This technique has been developed to evaluate cell‐mediated immune function, forecast the risk of infection, and monitor the rejection of solid organ transplants. 25 , 26 Regarding severe infections, certain studies have indicated that within the initial 24 h of ICU admission, there is a notable difference in iATP levels within CD4 + T lymphocytes between survivors and non‐survivors. The former group displays higher levels according to those studies.…”

“…The former group displays higher levels according to those studies. 26 , 27 However, no further analysis was carried out on its correlation with the absolute counts of CD4 + T lymphocytes and its predictive value on the risk of all‐cause mortality. The objective of this study is to investigate the prognostic significance of CD4 + T lymphocyte iATP levels in critically ill patients with infections.…”

The Potential of CD4+ T cells ATP level to indicate the Progression in NSCLC Patients

“…Measuring the activity levels of CD4 + T lymphocytes in the peripheral blood of patients to early identify the potential risks of rejection and infection in organ transplant recipients [21]. In sepsis, some studies have reported signi cantly higher sATP CD4 of survivors compared to non-survivors within the rst day of ICU admission [14,32]. These contrasting results indicate the complexity of sATP CD4 and its potential implications in different disease states.…”