title: Application of CD8+ Cells Count as a Guide of Immunosuppressive Regimen Introduction for Very Sick Patients Undergoing Liver Transplantation.
abstract: BACKGROUND
  Immunosuppression (IS) protocols should be individualized according to the individual recipient's immunity to minimize adverse effects. The aim of this study was to determine whether preoperative levels of CD8+ T lymphocytes could be used as a guide for the introduction of IS.
  
  
  METHODS
  Sixteen adult liver transplantations in our institute were retrospectively analyzed. The immunosuppressive agents were temporarily withheld for 8 patients with a lower (<10%) preoperative percentage of CD8+ cells after transplant (classified as group A). In this group, postoperative immunosuppressive agents had never been used until acute rejection was suspected. Another 8 patients receiving classic IS were classified as group B. We collected their demographic features and analyzed the clinical courses.
  
  
  RESULTS
  The postoperative IS-free period of group A was 5 to 120 days (median, 31 days). Our data showed an inverse correlation between CD8+ levels and the severity of liver disease. Although the IS-free protocol did not present a lower incidence of infection-related events, most of them were effectively treated with antibiotics. The 1-, 3-, and 5-year overall patient survival rates were not different between those with a short-term IS-free period and those with regular IS (87.5% vs 100%, 75% vs 100%, and 62.5% vs 87.5%; P = .468). No patient died of graft failure due to acute rejection.
  
  
  CONCLUSIONS
  Postoperative immunosuppressive agents can be safely withheld for a period of time to preserve proper immune responses against infections in very sick recipients guided by using the CD8+ levels.
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Electronic address: chenfanglee@gmail.com.
authors.forename: C-F
authors.initials: CF
authors.lastname: Lee
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Cheng
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: T-H
authors.initials: TH
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Chang-Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Chang-Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: R-S
authors.initials: RS
authors.lastname: Soong
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: T-J
authors.initials: TJ
authors.lastname: Wu
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: H-S
authors.initials: HS
authors.lastname: Chou
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: K-M
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Electronic address: weichen@cgmh.org.tw.
authors.forename: W-C
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000328:Adult; D018414:CD8-Positive T-Lymphocytes; D002985:Clinical Protocols; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000188:drug therapy; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008107:Liver Diseases / Q000097:blood* / Q000601:surgery; D016031:Liver Transplantation; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents