Polymorphonuclear leukocyte functions as predictive markers for infectionsafter organ transplantation

Infectious complications are still a major cause of morbidity and mortality after organ transplantation, and early therapy would certainly reduce the risk associated with severe infections. We therefore investigated the signi ficance of polymorphonuclear leukocyte (PMN) functional tests as predictive markers for infection in transplant patients under immunosuppressive thera py in a longitudinal study. In 41 patients, blood PMN migration and reactiv e oxygen species release, the blood levels of PMN elastase, malondialdehyde . neopterin, sICAM-1 and sVCAM-1, and urine neopterine were measured in 3- and 4-day intervals after liver-, kidney-, kidney-pancreas-, and heart and lung transplantation. PMN migration was determined in whole blood and estim ated by the amount of PMNs to penetrate into a membrane filter upon FMLP st imulation. Three groups of patients were formed according to their postoper ative course. Group I patients (n = 23) had no or only minor local infectio n, group II patients (n = 11) had infections with distinct systemic involve ment, and group III patients (n = 7) developed sepsis. A first elastase-lev el of over 100 mg/L after surgery, followed by a drop in the amount of bloo d PMNs ready to migrate, on FMLP stimulation, to below 12%, turned out to b e a marker for impending infection, whereas all other parameters tested wer e not predictive. In six of seven group ITI patients, this marker became po sitive (sensitivity 85.7 %) up to 15 days before clinical manifestation of sepsis. In group I (largely uneventful recovery) only one of 23 patients wa s positive (specificity 95.6%), whereas group II patients were in between ( 4 of 11 positive). By this method it seems possible to diagnose severe infe ctions in the preclinical phase, which may help prevent them if treatment i s begun promptly.