Review
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World J Transplant. Mar 24, 2014; 4(1): 30-39
Published online Mar 24, 2014. doi: 10.5500/wjt.v4.i1.30
Immune monitoring post liver transplant
Siddharth Sood, Adam G Testro
Siddharth Sood, Adam G Testro, Liver Transplant Unit Victoria, Level 8 HSB, Austin Health, University of Melbourne, Melbourne, Victoria 3084, Australia
Author contributions: Sood S and Testro AG were involved in the writing of this manuscript.
Correspondence to: Adam G Testro, Head of Liver Immunology Research, Liver Transplant Unit Victoria, Level 8 HSB, Austin Health, University of Melbourne, Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia. adam.testro@austin.org.au
Telephone: +61-3-94965353 Fax: +61-3-94963487
Received: November 27, 2013
Revised: January 14, 2014
Accepted: January 17, 2014
Published online: March 24, 2014
Abstract

Many of the causes of short and late morbidity following liver transplantation are associated with immunosuppression or immunosuppressive medications. Current care often involves close monitoring of liver biochemistry as well as therapeutic drug levels. However, the postoperative course following liver transplantation can often be associated with significant complications including infection and rejection, suggesting an inadequacy in current immune function monitoring. Many assays have been tested in the research setting to identify possible biomarkers that may be used to predict clinical events such as acute cellular rejection, and therefore allow modification of a patient’s immunosuppressive regimen prior to a clinical event. However, these generally require significant laboratory processing and have had difficulty becoming established in common clinical use outside the research setting. One assay, Cylex ImmuKnow has been food and drug administration approved but has had variable results. In this review we discuss the assays that have been used to assess monitoring of immune function after liver transplantation and consider possible future directions.

Keywords: Immune function monitoring, Review, Biomarkers, Liver transplantation

Core tip: Although many research assays have attempted to identify potential biomarkers that may be used to monitor immune function after liver transplantation, most require significant laboratory processing and are not clinically feasible. The rejection cascade is complex and not completely understood, with many likely interactions between innate and adaptive immune processes. Therefore, no single test is likely to provide a fool-proof window to the immune response and a combination of assays may be necessary. However, nothing can replace the clinical judgement of an expert transplant clinician for pooling together data to individualize immunosuppression therapy.