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Monitoring cell‐mediated immunity during immunosuppression reduction in heart transplant recipients with severe systemic infections
Author(s) -
Weston Mark W.,
RindeHoffman Debbie,
LopezCepero Mayra
Publication year - 2020
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.13809
Subject(s) - immunosuppression , medicine , heart transplantation , immunology , transplantation , cellular immunity , immune system
Background Treatment for severe systemic infections in heart transplantation is reduction in immunosuppression while treating the infection. An assay that measures adenosine triphosphate production in activated lymphocytes (ImmuKnow ® ) objectively monitors cellular immunity of transplant recipients. In this study, we used ImmuKnow ® to adjust immunosuppression in heart transplant recipients with severe systemic infections. Methods Heart transplant recipients were followed with ImmuKnow ® at the time of biopsy and diagnosis of systemic infection. Patients who developed an infection were monitored by ImmuKnow ® assay with adjustments in immunosuppression based upon the results of the assay. Maintenance immunosuppression was reinstituted when the ImmuKnow ® increased to >225 ng/mL of ATP. Results Two or more ImmuKnow ® assays were performed in 80 patients. Thirteen patients developed severe systemic infections. ImmuKnow ® mean value at the time of diagnosis of infection was 109 ± 49.2 ng/mL. Reduction in immunosuppression and treatment of infection resulted in normalization of ImmuKnow ® level, resolution of infection, and no episodes of rebound rejection. Conclusion Heart transplant recipients with severe systemic infections presented with a decreased ImmuKnow ® , suggesting over immunosuppression. ImmuKnow ® can be used as an objective measurement in withdrawing immunosuppression in heart transplant recipients with severe systemic infections.