Dynamic changes of cellular immune function and individualized adjustments of immunosuppressant for the management of severe infection after liver transplantation / 中华器官移植杂志

ABSTRACT

Objective To explore the dynamic changes of the cellular immune function in severe infection after liver transplantation, and to guide the individualized immunology adjustment. Methods 378 cases of livertransplantation were analyzed retrospectively. Seventy-four cases (infection group) suffered serious infection, including 54 cases cured (cure group), 20 cases died (death group). Fifty cases without infection and rejection were randomly selected as control group (stable group). According to the individualized adjusting proposal of immunosuppressants, 74 patients with severe infection were divided into two groups traditional (T) group and individualized (Ⅰ) group. The general condition, recovery rate and change of cellular immune function pre- and post-treatment were analyzed. Results The preoperative MELD score and the intraoperative blood loss in infection group were significantly higher than stable group, and those in death group were higher than in cure group. CD4+ T lymphocyte counts and lymphocyte counts in stable group were increased significantly from first week post-operation to discharge. The two indicators in infection group at first week postoperation and the onset of infection were lower than in stable group (P<0. 01). In cure group after infection was controlled the two indicators were higher than at first week post-operation and the onset of infection (P<0. 01), while in death group they were reduced up to death (P<0. 05). There was no significant difference in age, preoperative MELD score and the immune function indicators both at first week post-operation and the onset of infection between T group and Ⅰ group, except the intraoperative blood loss in Ⅰ group was greater than in T group. The recovery rate in Ⅰ group (90. 5 %)was higher than in T group (66.0 %). Conclusion Individualized adjustments of immunosuppressants guided according to the dynamic changes of cellular immune function helped to improve the prognosis of severe infection after liver transplantation.