title: Individualized Immunosuppressive Protocol of Liver Transplant Recipient Should be Made Based on Splenic Function Status.
abstract: BACKGROUND
  Lymphocyte subsets play important roles in rejection in liver transplant recipients, and the effect of splenic function on these roles remains unknown. The aim of this study was to explore the feasibility to adjust immunosuppressive agents based on splenic function status through detecting the lymphocyte subsets in liver transplantBeijing recipients.
  
  
  METHODS
  The lymphocyte subsets of 49 liver transplant recipients were assessed in the 309th Hospital of Chinese People's Liberation Army between June 2014 and August 2015. The patients were divided into splenectomy group (n = 9), normal splenic function group (n = 24), and hypersplenism group (n = 16). The percentages and counts of CD4+ T, CD8+ T, natural killer (NK) cell, B-cell, regulatory B-cell (Breg), and regulatory T-cell (Treg) were detected by flow cytometer. In addition, the immunosuppressive agents, histories of rejection and infection, and postoperative time of the patients were compared among the three groups.
  
  
  RESULTS
  There was no significant difference of clinical characteristics among the three groups. The percentage of CD19+CD24+CD38+ Breg was significantly higher in hypersplenism group than normal splenic function group and splenectomy group (3.29 ± 0.97% vs. 2.12 ± 1.08% and 1.90 ± 0.99%, P = 0.001). The same result was found in CD4+CD25+FoxP3+ Treg percentage (0.97 ± 0.39% vs. 0.54 ± 0.31% and 0.56 ± 0.28%, P = 0.001). The counts of CD8+ T-cell, CD4+ T-cell, and NK cell were significantly lower in hypersplenism group than normal splenic function group (254.25 ± 149.08 vs. 476.96 ± 225.52, P= 0.002; 301.69 ± 154.39 vs. 532.50 ± 194.42, P= 0.000; and 88.56 ± 63.15 vs. 188.33 ± 134.51, P = 0.048). Moreover, the counts of CD4+ T-cell and NK cell were significantly lower in hypersplenism group than splenectomy group (301.69 ± 154.39 vs. 491.89 ± 132.31, P= 0.033; and 88.56 ± 63.15 vs. 226.00 ± 168.85, P = 0.032).
  
  
  CONCLUSIONS
  Splenic function status might affect the immunity of liver transplant recipients, that should be considered when we make immunosuppressive protocols.
authors.affiliation: Department of Education, Chinese People's Liberation Army Medical School, Beijing 100853, China.
authors.forename: Ji-Yong
authors.initials: JY
authors.lastname: Song
authors.affiliation: Department of Hepatobiliary, Organ Transplant Institute, The 309th Hospital of Chinese People's Liberation Army, Beijing 100091, China.
authors.forename: Guo-Sheng
authors.initials: GS
authors.lastname: Du
authors.affiliation: Department of Hepatobiliary, Organ Transplant Institute, The 309th Hospital of Chinese People's Liberation Army, Beijing 100091, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Department of Hepatobiliary, Organ Transplant Institute, The 309th Hospital of Chinese People's Liberation Army, Beijing 100091, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Hepatobiliary, Organ Transplant Institute, The 309th Hospital of Chinese People's Liberation Army, Beijing 100091, China.
authors.forename: Long-Long
authors.initials: LL
authors.lastname: Suo
authors.affiliation: Department of Hepatobiliary, Organ Transplant Institute, The 309th Hospital of Chinese People's Liberation Army, Beijing 100091, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Hepatobiliary, Organ Transplant Institute, The 309th Hospital of Chinese People's Liberation Army, Beijing 100091, China.
authors.forename: Li-Kui
authors.initials: LK
authors.lastname: Feng
authors.affiliation: Department of Education, Chinese People's Liberation Army Medical School, Beijing 100853, China.
authors.forename: Bing-Yi
authors.initials: BY
authors.lastname: Shi
mesh_terms: D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000276:immunology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007694:Killer Cells, Natural / Q000187:drug effects / Q000276:immunology; D016031:Liver Transplantation / Q000379:methods*; D016131:Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D013154:Spleen / Q000187:drug effects / Q000276:immunology*; D050378:T-Lymphocytes, Regulatory / Q000187:drug effects / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus