Serum Albumin and Neutrophils in Patients With End-Stage Liver Disease: Relationships With ATP Levels in CD4-Positive T Cells.

Abstract

Aims: The ImmuKnow assay measures ATP levels in CD4 T cells, thereby quantifying cell-mediated immunity and providing an insight into the immune status of the transplant recipient. Methods: In this study, we examined the correlations between ATP levels in pre- and post-transplant recipients and various factors, including the Model for End-Stage Liver Disease (MELD) score, white blood cell counts, including neutrophils, lymphocytes, platelets, and monocytes, fibrinogen, albumin, and CD3-, CD4-, CD8-, and CD19-positive lymphocytes. Results: A total of 52 blood samples were taken from 12 patients with end-stage liver disease and from healthy volunteers. ATP levels were measured by ImmuKnow assay and other clinical laboratory parameters were analyzed. Ten of the 12 patients underwent living-donor liver transplantation (LDLT). The patients included six males and six females, with an average age of 40.23 ± 19.42 years (range 0.8 - 57). The average MELD score was 18.9 ± 3.8 (range 13 - 24). ATP levels in the 12 patients before LDLT were significantly lower than those in healthy volunteers (111.9 ± 81.8 vs 355.3 ± 78.2 ng/mL, P < 0.0001). ATP levels increased markedly after LDLT (322.7 ± 118.9 at 7 post-transplant days, 410.2± 213.7 at 14 post-transplant days). Five episodes, including portal thrombosis, sepsis, and fibrosing cholestatic hepatitis C (FCH) developed in four patients. Among these, ATP levels were significantly lower in the patients with FCH and sepsis (35.3 ± 28.5). There were significant correlations between ATP levels in the 12 pre-transplant patients and white blood cell (R2=0.59, P < 0.05) and neutrophil counts (R2=0.70, P < 0.05), and levels of serum albumin (R2=0.38, P < 0.05). However, there were no significant correlations between ATP levels after LDLT and other laboratory factors. Conclusions: In this study, we demonstrated significant correlations between ATP levels and white blood cell and neutrophil counts, and levels of serum albumin in patients with pre-transplant end-stage liver disease. The ImmuKnow assay could thus be useful for monitoring immunological outcomes following LDLT, including the development of bacterial and viral infections.