title: The relationship between adenosine triphosphate within CD4(+) T lymphocytes and acute rejection after liver transplantation.
abstract: BACKGROUND
  There have been increasing interests in the relationship between CD4(+) T lymphocytes and acute rejection (AR) in transplantation. In this study, we explore the role of CD4(+) T lymphocytes after liver transplantation.
  
  
  METHODS
  From February to October 2009, 87 patients underwent liver transplantation. They were divided into the AR group and non-acute rejection (NAR) group, with 56 healthy individuals in the control group. Blood specimens were collected preoperatively and at one, two, and four wk postoperatively for all groups and also on the day when AR occurred and one wk after intravenous glucocorticoid therapy for the AR group. Adenosine triphosphate (ATP) levels were measured using the ImmuKnow™ test kits for immune cell functions.
  
  
  RESULTS
  After transplantation, the ATP levels within CD4(+) T lymphocytes were significantly elevated in the two groups when compared with the preoperative levels. It peaked in the AR group and was significantly higher than that of the NAR group (p < 0.05). By ROC curve analysis, the obvious elevation of the ATP value one wk after transplantation had better sensitivity and specificity in diagnosing the AR. The ATP sensitivity rate for early AR was 85.7% and specificity rate 80.9% when the cutoff value was 407 μg/L. The ATP value collected on the day of AR occurrence has apparently positive correlation with the rejection acting index (RAI) (p < 0.01). After the intravenous glucocorticoid therapy, all the ARs were reversed and the ATP value declined significantly compared with the control group and that on the day when AR occurred (p < 0.01).
  
  
  CONCLUSIONS
  During the early postoperative period (especially at first week after liver transplantation), the elevation of ATP levels within CD4(+) T lymphocytes has good sensitivity and specificity in diagnosing the AR at early stage. And the degree of AR has positive relationship with ATP value. After the intravenous glucocorticoid therapy, the obvious declination of AR might be used in evaluating the effectiveness of anti-rejection treatment.
authors.affiliation: Department of Organ Transplantation, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Jia-Yong
authors.initials: JY
authors.lastname: Dong
authors.forename: Hao
authors.initials: H
authors.lastname: Yin
authors.forename: Rui-Dong
authors.initials: RD
authors.lastname: Li
authors.forename: Guo-Shan
authors.initials: GS
authors.lastname: Ding
authors.forename: Zhi-Ren
authors.initials: ZR
authors.lastname: Fu
authors.forename: You-Min
authors.initials: YM
authors.lastname: Wu
authors.forename: Zheng-Xin
authors.initials: ZX
authors.lastname: Wang
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism*; D000328:Adult; D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology* / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D008107:Liver Diseases / Q000628:therapy; D016031:Liver Transplantation / Q000276:immunology*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D000255:Adenosine Triphosphate