title: An immune function assay predicts post-transplant recurrence in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  An immune function assay has been proposed as a new strategy to monitor immunosuppression after organ transplantation. However, there are limited data regarding its role in liver transplant recipients with hepatocellular carcinoma (HCC). In this study, we sought to determine the utility of this functional assay in assessing the risk of infection, rejection, and tumor recurrence in liver transplant recipients.
  
  
  METHODS
  Immune function was determined by ImmuKnow assay that measures the amount of adenosine triphosphate (ATP) produced by CD4 (+) T cells to monitor the global immune status in 342 whole blood samples from 105 liver transplant recipients. The association between ATP value and post-transplant tumor recurrence was evaluated in 60 HCC patients. The ATP value in predicting tumor recurrence in other independent cohort of 92 recipients with HCC was analyzed prospectively.
  
  
  RESULTS
  The mean ATP values of liver transplant recipients with infection (145.2 ± 87.0 ng/ml) or acute rejection (418.9 ± 169.5 ng/ml) were different from those with stable state (286.6 ± 143.9 ng/ml, P < 0.05). In recipients with HCC who developed recurrent tumors, the values were significantly lower than those without recurrence (137.8 ± 66.4 vs. 289 ± 133.9 ng/ml, P < 0.01); the optimal threshold value to predict post-transplant tumor recurrence was 175 ng/ml. Comparing with the patients in lower immune group (ATP ≤ 175 ng/ml), patients in the higher immune group (ATP > 175 ng/ml) experienced significantly better disease-free survival (P < 0.01). Multivariate Cox regression analysis showed the ATP value was an independent predictor of HCC recurrence.
  
  
  CONCLUSIONS
  The immune function assay has the potential to assess the risk of infection and rejection in liver transplantation and to predict post-transplant tumor recurrence in recipients with HCC.
authors.affiliation: Department of Liver Surgery, Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China.
authors.forename: Jian-Wen
authors.initials: JW
authors.lastname: Cheng
authors.forename: Ying-Hong
authors.initials: YH
authors.lastname: Shi
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Xiao-Wu
authors.initials: XW
authors.lastname: Huang
authors.forename: Shuang-Jian
authors.initials: SJ
authors.lastname: Qiu
authors.forename: Yong-Sheng
authors.initials: YS
authors.lastname: Xiao
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
authors.forename: Zhi
authors.initials: Z
authors.lastname: Dai
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models
chemical_list: D007166:Immunosuppressive Agents; D000255:Adenosine Triphosphate