Experience with immune monitoring in lung transplant recipients: correlation of low immune function with infection.
BACKGROUND
Lung transplants, in particular, have the highest rate of infections among solid organ transplant recipients. However, there is no existing objective measure to predict the development of infections. We report the correlation between Cylex ImmuKnow (ng/mL ATP) values and various infectious syndromes in a large prospective cohort of lung transplant recipients.


METHODS
We followed up 175 lung transplants that developed 129 infectious episodes. Multiple logistic regression analysis was performed; generalized estimating equations were used to determine the odds ratio for infections.


RESULTS
The median ImmuKnow values in cytomegalovirus disease (49.3 ng/mL ATP), viral infection (70 ng/mL ATP), and bacterial pneumonia (92 ng/mL ATP) were significantly different from stable state (174.8 ng/mL ATP). The median ImmuKnow values of fungal disease (85 ng/mL ATP) and tracheobronchitis (123 ng/mL ATP) had a tendency to be lower than stable state (P=0.10), whereas patients with fungal colonization had comparable ImmunKnow values (167 vs. 174.8 ng/mL ATP). Of the patients colonized with fungus who subsequently developed fungal disease within 100 days, the median value of ImmuKnow was significantly lower than in those who did not develop fungal disease (22.5 vs. 183.5 ng/mL ATP; P<0.0001). Generalized estimating equation regression analysis showed ImmuKnow values less than or equal to 100 ng/mL ATP to be an independent predictor of infections (odds ratio 2.81).


CONCLUSIONS
Cylex ImmuKnow assay monitoring has the potential to identify the patients at risk of developing infection and those colonized with fungus that are at risk of developing disease.
Husain
Shahid
S
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. shahid.husain@uhn.on.ca
Raza
Kashif
K
Pilewski
Joseph M
JM
Zaldonis
Diana
D
Crespo
Maria
M
Toyoda
Yoshi
Y
Shutt
Kathleen
K
Spichty
Kathy
K
Bentlejewski
Carolyn
C
Pakstis
Diana L
DL
Carey
Mary Ellen
ME
McCurry
Kenneth R
KR
Zeevi
Adriana
A
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology; D003622:Dapsone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology*; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000379:methods*; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014777:Virus Diseases / Q000188:drug therapy / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D003622:Dapsone