BACKGROUND: Transplant recipients have a high risk of infection due to overimmunosuppression. However, underimmunosuppression carries with it the risk of rejection. It would be necessary to have a test that could differentiate between infection and rejection in renal transplant patients. The ImmuKnow based on the measurement of intracellular ATP in stimulated CD4 T cells to assess CMI in transplant recipients. Our objective is to evaluate the clinical value of ATP determination in CD4+ cells in transplant recipients. METHODS: ATP level of CD4⁺ T cells was measured by ImmuKnow kit (ImmuKnow assay, Cylex, Inc), The ATP levels were measured in 267 renal transplant recipients before and 7,14,30,90d,180d after operation, and at the time of infection and acute rejection(AR). We searched for associations between ATP levels and infection or AR, analysis of variance (ANOVA), Pearson-Spearman and relative risks were used for analysis of data. RESULTS: ATP concentrations in CD4 ⁺ T cells were significantly lower after operation than those before operation (P<0.01). ATP concentrations reached the lowest about day 90 after operation, and were significantly lower than those of any other time after operation (P<0.05), then increased gradually. In 18 recipients with serious infection, the ATP levels in before and 30, 90d after operation, at the time of infection and 4w after treatment were (382±179)ng/ml, (269±153)ng/ml, (189±105) ng/ml,(142±103)ng/ml and (243±126)ng/ml respectively, ATP levels at the time of infection were significantly lower than those of any other time(P<0.05). ATP results and infection showed a significant negative correlation. In 25 recipients with biopsy-proven AR, the ATP levels in before and 7d after operation, at the time of AR and 1w after treatment were (393±182)ng/ml, (378±165)ng/ml, (521±226) ng/ml and (282±109)ng/ml respectively, ATP levels at the time of AR were significantly higher than those of any other time(P<0.05) and those of the contemporary non –acute rejection recipients. ATP results and infection showed a significant positive correlation. CONCLUSIONS: The determination of ATP in CD4+ cells could reflect the status of CMI, and is helpful in determining the risk of developing infection or rejection. The ImmuKnow assay of CMI could serve as a valuable tool for immune monitoring in organ transplantation.

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