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Aims The aim of this study is to analyze intracellular adenosine-tri-phosphate (iATP) levels in pediatric liver transplant (PLT)recipients and to investigate its correlation with patients clinical status.Methods Sixty-five PLT patients were recruited to this study.Patients were divided into clinically stable,infection groups.Association of iATP levels with episodes of infection was analyzed.Results Among 63 patients,120 iATP values were obtained including serial iATP measurements from 35 patients (55.6%).The average iATP value of the 64samples from 39 clinically stable children was 372 ± 225ng/m.High inter-individual iATP variability was observed in clinically stable patients and iATP levels appeared stable in individual patients with serial data.24 PLT recipients with infection had significantly lower iATP at time of infection compared with clinically stable recipients (P <0.001).Serial measurements indicated that the average iATP value decreased significantly as infection progressed (P <0.001),and increased as infection resolved (P =0.036).However,12 of the 39 clinically stable patients with low iATP values (iATP <225 ng/ml) showed no active infection,while 8 of the 24 infected patients showed high levels of iATP during infection (iATP >225ng/ml).Conclusion Compared with clinically stable patients,lower iATP levels were observed in infected PLT recipients.Levels became elevated as infection resolved.The inter-individual variability observed in our study indicates that cut-off values of iATP may not be suitable for defining immune status.Serial monitoring data may be more helpful to determine the cellular immune response in PLT recipients.