Invasive fungal infection after liver transplantation: Risk factors and significance of immune cell function monitoring

OBJECTIVE: Monitoring immune status in transplant recipients is essential for predicting the risk of infections. The aims of the study were to identify the correlation of a low ImmuKnow adenosine triphosphate (ATP) value with the development of invasive fungal infections (IFIs) and whether this is an independent risk factor for IFIs in liver recipients. METHODS: We followed up 248 liver recipients who developed 157 infectious episodes. Peripheral CD4(+) T cells were selected freshly for ATP detection. Percentages of T-helper (Th, CD3(+)CD4(+)) and T-suppressor (Ts, CD3(+)CD8(+)) lymphocyte subgroups were also examined. RESULTS: Overall 44 patients (17.7%) were diagnosed as IFIs, of whom 9 (20.5%) died. The average ImmuKnow ATP value in the IFI patients (109 +/- 78 ng/mL) was significantly lower than that in common bacterial infections (174 +/- 106 ng/mL, P < 0.01) or stable liver recipients (314 +/- 132 ng/mL, P < 0.01), while there was no difference in the Th/Ts ratio among each group. Logistic regression analysis showed ImmuKnow ATP value less than 100 ng/mL was an independent risk factor of IFI (OR = 3.44, P = 0.0237). ImmuKnow ATP values had no correlation with lymphocytes or their subgroups, but tended to correlate with the number of neutrophils and total white blood cells. CONCLUSIONS: ImmuKnow assay monitoring has the potential to identify the patients at risk of developing IFI after liver transplantation (LT), which may provide a feasible measure for optimizing liver recipients' immune cellular function after transplantation.