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Utility of an immune cell function assay to differentiate rejection from infectious enteritis in pediatric intestinal transplant recipients
Author(s) -
Wozniak Laura J.,
Venick Robert S.,
Gordon Burroughs Sherilyn,
Ngo Khiet D.,
Duffy John P.,
Farmer Douglas G.
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12303
Subject(s) - medicine , immunosuppression , immune system , clinical significance , gastroenterology , transplantation , immunology , statistical significance
The C ylex I mmune C ell F unction A ssay measures cell‐mediated immunity based on ATP production by stimulated CD 4 + cells. We hypothesized that this test would discriminate acute cellular rejection ( ACR ) from infectious enteritis ( IE ) in pediatric intestinal transplant ( IT x) recipients with allograft dysfunction. We retrospectively analyzed 224 C ylex assays drawn in 47 children who received 53 IT x. Samples were classified as stable, ACR , or IE based on clinical status. ATP values were analyzed using Kruskal–Wallis and t ‐tests. Overall, there was a statistically significant difference in ATP values based on clinical status (p = 0.03); however, overlap was observed between groups. The median ATP value during ACR was significantly greater than during stable periods (p = 0.02). No difference was seen in IE vs. stability (p = 0.8). The difference in median ATP value in ACR vs. IE approached significance (p = 0.1). Relative to previous levels, ACR episodes were associated with a median ATP increase of 101 ng/ mL and IE episodes with a decrease of 3 ng/ mL (p = 0.3). These data indicate that the C ylex assay has limited utility in differentiating ACR from IE , largely due to interpatient variability. Following longitudinal intrapatient trends may be an adjunctive tool in discriminating IE from ACR and guiding immunosuppression adjustments in select patients.