title: Assessing immunologic function through CD4 T-lymphocyte ahenosine triphosphate levels by ImmuKnow assay in Chinese patients following renal transplantation.
abstract: OBJECTIVE
  Balancing immunosuppression to prevent rejection while minimizing infection/drug toxicity risk is a challenge in organ transplantation. Drug monitoring alone or with functional monitoring is inadequate to measure the immune response after transplantation. The Food and Drug Administration (FDA)-approved immune monitoring assay, ImmuKnow, offers an noninvasive method to assess the immune status of transplanted patients by measuring adenosine triphosphate (ATP) released from CD4 T cells. Herein, we have evaluated ATP levels reflecting the immune responses of Chinese kidney transplant recipients as a monitoring parameter to guide treatment after transplantation.
  
  
  METHODS
  From October 2008 to March 2010, we recruited 259 kidney transplant patients who were divided into four groups: stable (n = 174), postoperative infection (n = 32), postoperative rejection (n = 16), and high-dose corticosteroid treatment (n = 33). The ImmuKnow assay was performed to measure CD4 T-cell ATP levels. No prisoners or organs from prisoners were used in the study.
  
  
  RESULTS
  Receiver operating characteristics measurements indicated an ATP predictive range of 238 to 497 ng/mL to monitor immune responses after transplantation and immunosuppressive therapy. To identify patients with infection, we used a cutoff ATP value of 238 ng/mL with 100% specificity and positive predictive value and 92.9% sensitivity. To identify patients with rejection, we used a value of 497 ng/mL with 91.5% sensitivity. Compared with the 225 to 525 ng/mL ATP levels recommended by the FDA, our target values showed similar or better diagnostic accuracy.
  
  
  CONCLUSIONS
  We provide additional data to monitor immunosupressant treatment of Chinese kidney transplant patients.
authors.affiliation: Department of Urology, Fuzhou General Hospital, Fujian Medical University, Second Military Medical University, Fuzhou, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Zhou
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
authors.forename: L
authors.initials: L
authors.lastname: Ma
authors.forename: W
authors.initials: W
authors.lastname: Wu
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.forename: X
authors.initials: X
authors.lastname: Yuan
authors.forename: L
authors.initials: L
authors.lastname: Wu
authors.forename: X
authors.initials: X
authors.lastname: Lin
authors.forename: J
authors.initials: J
authors.lastname: Tan
mesh_terms: D000255:Adenosine Triphosphate / Q000097:blood*; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism*; D002681:China; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D016030:Kidney Transplantation; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D000255:Adenosine Triphosphate