Posttransplant Inflammation Associated With Onset of Chronic Kidney Disease

• Published in: Transplantation proceedings 2010-10, Vol.42 (8), p.2896-2898
• Main Authors: Sancho, A, Pastor, M.C, Bayés, B, Sánchez, A, Morales-Indiano, C, Doladé, M, Romero, R, Lauzurica, R
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cross-Sectional Studies; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Kidney Failure, Chronic - surgery; Kidney Transplantation; Kidneys; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nephritis - etiology; Nephrology. Urinary tract diseases; Postoperative Complications; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Urinary system involvement in other diseases. Miscellaneous
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.07.075

Abstract Background Chronic allograft nephropathy (CAN), a major complication in renal transplant patients, is an important cause of graft loss. Inflammation as measured in the pretransplant and posttransplant phases, using various markers, has been associated with worse renal function and a greater risk of cardiovascular disease and of long-term graft loss. Objective The objective of our study was to evaluate whether worsening inflammation in the first 3 months postoperatively was a risk factor for developing CAN. Patients and methods We performed a cross-sectional study in 207 patients. The following markers of inflammation (MIF) were determined pretransplant and at 3 months after grafting: C-reactive protein (CRP) (mg/L), interleukin (IL)-6 (pg/mL), IL-10 (pg/mL), tumor necrosis factor (TNF)-α (pg/mL), and its soluble receptor (ng/mL), soluble-IL2R (UI/mL), pregnancy-associated plasma protein A (PAPP-A; mUI/L), and IL-4 (pg/mL). We also calculated the ratio at 3 months versus the pre value of MIF. Results CAN was diagnosed after the first year in 23 patients (11.3%) always by renal biopsy performed for clinical indications. Patients with CAN showed worse inflammation, eg, MIF ratios over one, with statistically significant differences for the ratios of TNF-α and PAPP-A ( P = .032 and P = .051 respectively). Upon multivariate logistic regression analysis, using CAN as the dependent variable and age, sex, donor age, months on dialysis, acute tubular necrosis, acute rejection, and MIF ratios as covariates, we observed that an acute rejection episode (OR = 13.03; CI = 2.8–60.9; P = .001), CRP ratio (OR = 1.36; CI = 1.07–1.73; P = .013), and PAPP-A ratio (OR = 1.80; CI = 0.92–3.53; P = .005) were independent markers of CAN. Conclusions Among other factors, inflammation may determine the onset of CAN as diagnosed by renal biopsy.