Personalized Infection Risk Stratification After Liver Transplantation: Integration of Immune Function and Tacrolimus Monitoring

Abstract

Liver transplantation, while life-saving, presents ongoing challenges related to immune management and infection risk. Traditional laboratory tests inadequately reflect immune function, underscoring the need for more precise monitoring tools. The ImmuKnow assay, which quantifies adenosine triphosphate (ATP) released by activated T lymphocytes, has shown potential in assessing immune reserve but exhibits inconsistent predictive capacity for infections when used alone. This study evaluates the utility of a multivariate model combining ATP levels by blood CD4+ lymphocytes, indicative of immune function, and Tacrolimus doses, which reflect the level of immunosuppressive therapy during the third week post-transplantation, demonstrating high predictive accuracy for infection risk (AUC = 0.9242). Logistic regression revealed that the interaction between ATP and Tacrolimus levels significantly correlates with infection susceptibility, allowed effective risk stratification into high- and low-risk categories, achieving a sensitivity of 100% and specificity of 75%. The integration of these parameters into an interactive, patient-specific risk assessment algorithm facilitates dynamic adjustments of immunosuppressive therapy, aiming to optimize individual patient outcomes. These findings highlight the importance of combined immunopharmacological monitoring for advancing personalized post-transplant management strategies.