Immune monitoring post liver transplant

Table 1 Clinically available immune monitoring after adult liver transplantati

	Sensitivity	Specificity
Currently available
Liver biochemistry	High	Low
Therapeutic drug levels	Low	Low
ImmuKnow	Low	High
Liver histology	Gold standard	Gold standard
Future possibilities
PlexImmune	Only Paedeatric studies published
? Combination assays

Table 2 Summary of assays for immune function monitoring

		Advantages	Disadvantages
Antigen-specific assays:	Limiting dilution aAssays, mixed lymphocyte reactions, ELISPOT	Measure individual antigen specific response	Need donor cells, Laboratory intensive
Antigen non-specific:	ImmuKnow	Available, FDA approved	Inconsistent results
	Cytokine levels/polymorphisms		Inconsistent results
	Immune competence scores	Readily available	Lack of published validation studies
	Regulatory T cells (Tregs)	Associated with rejection	Laboratory intensive. Lack of published validation studies
	Soluble CD30		Lack of association with clinical outcomes in OLTx
Identifying operational tolerant recipients:	Tregs, Gene expression, dendritic cell types, delayed type hypersensitivity	Able to identify recipients in whom immunosuppression could be withdrawn	Laboratory intensive. Only few recipients suitable

FDA: Food and drug administration; ELISPOT: Enzyme-linked immunosorbent spots; OLTx: Liver transplantation.