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CELL MEDIATED IMMUNE RESPONSE IN THE LIVER TRANSPLANT PATIENT WITH HEPATITIS C: REJECTION VS RECURRENCE.
Mayra M. Lopez-Cepero Ph.D. 1, James Huang M.D. 2, James Mayes M.D. 2, William M. LeFor Ph.D. 1 and Victor Bowers M.D. 2. 1 Transplant Immunology Laboratory, LifeLink Foundation and 2 LifeLink Health Care Institute, FL, USA .
Hepatitis C (HCV) infection is known to suppress host cellular immune response. The Immuknow assay measures the cell mediated immune response (CMI) by ATP release from CD4+ cells when stimulated with PHA (low = 225, moderate 226-524 and high > 525 ng/ml ATP). We determined the CMI in HCV+ vs HCV- patients. HCV+ patients have a low response compared to the moderate one seen in HCV- and healthy controls. This assay corroborates previous findings that CMI response is impaired and decreased in HCV + patients with end stage liver disease waiting for a TPX. This assay performed prior to TPX establishes a baseline CMI response that can be compared to the CMI response in the post-transplant setting to monitor adequacy of immune suppression (IS) and/or to indicate possible rejection. Post liver transplant IS management is difficult in patients with HCV. Over aggressive IS may lead to HCV recurrence and sub optimal IS may lead to graft rejection. Biopsies to assess HCV recurrence vs rejection are often difficult to interpret due to similar histopathological process.Our results show that rejection is evident in HCV+ liver transplant recipients with strong/moderate ATP release. This finding implies sub-optimal IS and relatively intact host immunity. HCV recurrence is observed in patients with low ATP release suggesting adequate and/or over IS. In this latter group of patients, reduction of IS may be neccesary, in addition to HCV anti viral therapy. This assay when combined with histopathological findings and clinical picture may be helpful in post-TPX monitoring of IS, rejection or recurrence in HCV liver TPX recipients.