Search

Background. Low HLA-DR expression on monocytes is associated with an increased risk of infection after surgery or trauma. We determined the value of this parameter as a marker for sepsis after liver transplantation. Methods. The percentage of monocytes expressing HLA-DR was determined by flow cytometry before and after liver transplantation in nine patients. Five lung and 20 kidney transplant recipients served as controls. Results. Bacterial sepsis occurred in 5 of 9 liver transplant patients and 0 of 24 control patients. Monocyte HLA-DR expression decreased 50% in the four liver transplant patients without sepsis. Only 1 of 25 control patients had persistently low monocyte HLA-DR expression. Conclusions. Monitoring of monocyte HLA-DR expression may be helpful in identifying liver transplant patients who have an increased risk of imminent bacterial sepsis.

We retrospectively analyzed the incidence and outcome of steroid-resistant rejection (SRR) during the first 6 months after OLT in 126 patients receiving triple immunosuppression. A total of 95 patients either did not experience acute rejection at all or had acute rejection that subsided without additional treatment. A total of 31 patients had biopsy-proven acute rejection that required therapy: 18 patients had acute rejection that responded to steroid therapy (steroid-sensitive rejection, SSR); the remaining 13 patients had SRR and received ATG, At the onset of acute rejection, no differences in clinical, biochemical, or immunological parameters were present between patients with SR and SRR. However, the histological grade of acute rejection in the initial biopsy was higher in patients with SRR (P = 0.05), ATG treatment was effective in 10 of the 13 patients and was not associated with an increased incidence of opportunistic infections. Patient and graft survival rates at 2 years were comparable In the three groups. These data show that the incidence of SRR during the first 6 months after OLT is low and that its treatment with ATG is both effective and well tolerated.

Cytomegalovirus (CMV), a member of the Herpes virus family, is a seemingly harmless infectious agent for healthy individuals. However, it is one of the most important opportunistic pathogens in immunosuppressed patients, particularly in organ transplant recipients. Due to its monocytotropic character, CMV exhibits an intimate relationship with the host immune system, and is therefore of great interest to immunologists. In this review, a summary is given of recent developments in our understanding of the interaction between CMV and the host immune system and guidelines are provided for the clinical management of this infection.