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Low HLA-DR expression on monocytes as a prognostic marker for bacterial sepsis after liver transplantation
J M van den Berk1, R H Oldenburger, A P van den Berg
1Department of Clinical Immunology, University Hospital, Groningen, The Netherlands.
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 all five patients with sepsis. HLA-DR expression dropped before (n=4) or at the time of sepsis (n=1), and remained low for 13 weeks. HLA-DR expression remained >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.