Low HLA‐DR expression on peripheral blood monocytes predicts bacterial sepsis after liver transplantation: relation with prednisolone intake

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Abstract
Bacterial sepsis remains a frequent complication after liver transplantation. We previously reported the results of a pilot study that suggested that low expression of HLA‐DR on monocytes is a predictive marker for the occurrence of sepsis. We have studied the value of this marker in an additional cohort of patients, and have analyzed the relation of HLA‐DR expression with the use of immunosuppressive agents. 20 adult liver transplantation patients were prospectively monitored during the first 4 weeks after transplantation. All were treated according to standard protocols. The percentage of monocytes expressing HLA‐DR was measured by flow cytometry. In addition, the effects of incubation of monocytes with prednisolonein vitroon the expression of HLA‐DR was determined in 7 healthy volunteers. Seven patients developed bacterial sepsis after a median 15 (range 10–20) days after transplantation. HLA‐DR expression was significantly lower in these patients on days 7, 14, 21, and 28 after transplantation compared with non‐septic patients. The percentage of HLA‐DR positive monocytes was 30% or less, 3 (1–8) days before onset of sepsis. On day 7 after transplantation, HLA‐DR expression on 50% or less of monocytes had a positive predictive value for sepsis of 71%, whereas the negative predictive value was 85%. Patients who developed sepsis received significantly more prednisolone. Incubation with prednisolonein vitrolowered the expression of HLA‐DR in a dose‐dependent manner. We conclude that low HLA‐DR expression on monocytes is a marker for a high risk of subsequent sepsis in liver transplantation patients. This high risk may be (at least partly) related to the dose of prednisolone.