Clinical application investigation of quantitative evaluation system of immune status in guiding individualized management of immunosuppressants after liver transplantation
10.3969/j.issn.1674-7445.2022.06.017
- VernacularTitle:免疫状态量化评估体系指导肝移植术后个体化免疫抑制药管理的临床应用探讨
- Author:
Yanan JIA
1
;
Jiqiao ZHU
;
Han LI
;
Wenli XU
;
Ruolin WANG
;
Shaocheng LYU
;
Jiantao KOU
;
Xianliang LI
;
Qiang HE
Author Information
1. Department of Hepatobiliary-pancreatic-splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
- Publication Type:Research Article
- Keywords:
Immune status assessment;
Immune score;
Liver transplantation;
Immunosuppressant management;
Rejection;
Opportunistic infection;
Lymphocyte subset;
Flow cytometry;
MingDao Immune Cell Analysis;
MingDao Immune System Score
- From:
Organ Transplantation
2022;13(6):803-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the guiding role of quantitative evaluation system of immune status in the individualized management of immunosuppressants for the recipients after liver transplantation. Methods Clinical data of 239 liver transplant recipients were retrospectively analyzed. MingDao Immune Cell Analysis (MICA) was established. All recipients were divided into two groups according to the adjustment regimens of immunosuppressants. The immunosuppressant regimen was adjusted according to MingDao Immune System Score (MISS) in the MISS group (n=84), and the medication plan was empirically adjusted during the same period in the control group (n=155). According to the time of postoperative detection (t), the recipients in the MISS group were divided into subgroup A (t ≤ 28 d, n=78), subgroup B (28 d < t ≤ 6 months, n=68), subgroup C (6 months < t ≤ 12 months, n=18), subgroup D (12 months < t ≤ 24 months, n=18) and subgroup E (t > 24 months, n=19). In the MISS group, postoperative MISS scores of recipients in subgroups A-E were analyzed. The incidence of acute rejection and opportunistic infection and the overall survival rate were statistically compared between the MISS and control groups. Results The MISS scores in subgroups A-E were -7.0 (-13.2, -2.0), -2.0 (-5.8, 1.8), -0.5 (-7.3, 2.8), -2.0 (-4.5, 3.3) and -3.0 (-6.0, 1.0), respectively. The immune status of the recipients was gradually improved over postoperative time, and the difference between two groups was statistically significant (P < 0.05). In the MISS group, 15% (13/84) of the recipients developed acute rejection, and 27% (42/155) in the control group, and the difference was statistically significant (P < 0.05). In the MISS group, the MISS score of the recipients with acute rejection was 0 (-2.5, 3.5), and -5.0 (-12.0, -1.0) for their counterparts without acute rejection, and the difference was statistically significant (P < 0.05). In the MISS group, 2% (2/84) of the recipients presented with postoperative opportunistic infection, and 9% (14/155) in the control group, and the difference was statistically significant (P < 0.05). In the MISS group, the 1- and 3-year overall survival rates were 86.9% and 79.8%, and 83.2% and 76.8% in the control group, and no significant difference was observed between two groups (P > 0.05). Conclusions MICA and MISS score may reflect the immune status of liver transplant recipients, and guide the individualized management of administration of immunosuppressants after liver transplantation.
