title: Experience with immune monitoring in lung transplant recipients: correlation of low immune function with infection.
abstract: 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.
authors: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. shahid.husain@uhn.on.ca
authors: Shahid
authors: S
authors: Husain
authors: Kashif
authors: K
authors: Raza
authors: Joseph M
authors: JM
authors: Pilewski
authors: Diana
authors: D
authors: Zaldonis
authors: Maria
authors: M
authors: Crespo
authors: Yoshi
authors: Y
authors: Toyoda
authors: Kathleen
authors: K
authors: Shutt
authors: Kathy
authors: K
authors: Spichty
authors: Carolyn
authors: C
authors: Bentlejewski
authors: Diana L
authors: DL
authors: Pakstis
authors: Mary Ellen
authors: ME
authors: Carey
authors: Kenneth R
authors: KR
authors: McCurry
authors: Adriana
authors: A
authors: Zeevi
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D003622:Dapsone