title: The anaphylatoxin C5a, a new parameter in the diagnosis of renal allograft rejection.
abstract: In the underlying study the diagnostic value of the anaphylatoxin C5a was evaluated in kidney transplantation. In 49 transplant patients the following parameters were measured daily for a mean period of 25.1 days: plasma C5a [P-C5a], urine C5a [U-C5a], serum amyloid A [SAA], serum neopterin [S-NEOP] and urine neopterin [U-NEOP]. Sensitivity, specificity and day of first significant parameter increase (exceeding a cut-off level of > 50%) were evaluated retrospectively during 30 periods of rejection and 30 periods of stable graft function. U-C5a was the parameter with the highest sensitivity (84%) and specificity (84%), increasing in the mean 1.3 days before clinical diagnosis of rejection. Sensitivity and specificity of the other markers was lower: SAA 77% and 77%, U-NEOP 68% and 65%, S-NEOP 45% and 77%, and P-C5a 45% and 48%, respectively. During four instances of cytomegalovirus disease extremely high U-NEOP (> or = 1520 +/- 518 mumol/mol creatinine) and slightly increased P-C5a levels (> or = 1.5 +/- 1.4 ng/ml) occurred. Elevated urinary excretion of C5a seems to be a reliable and early marker of renal allograft rejection. In combination with SAA and U-NEOP, the daily assessment of U-C5a differentiates between viral infection and allograft rejection.
authors.affiliation: Department of Nephrology/Centre of Internal Medicine, Philipps-University of Marburg, Germany.
authors.forename: T F
authors.initials: TF
authors.lastname: Müller
authors.forename: C M
authors.initials: CM
authors.lastname: Neumann
authors.forename: C
authors.initials: C
authors.lastname: Greb
authors.forename: M
authors.initials: M
authors.lastname: Kraus
authors.forename: H
authors.initials: H
authors.lastname: Lange
mesh_terms: D000328:Adult; D000368:Aged; D001708:Biopterins / Q000031:analogs & derivatives / Q000097:blood; D015936:Complement C5a / Q000032:analysis*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D019798:Neopterin; D012189:Retrospective Studies; D000685:Serum Amyloid A Protein / Q000032:analysis; D014184:Transplantation, Homologous
chemical_list: D000685:Serum Amyloid A Protein; D001708:Biopterins; D019798:Neopterin; D015936:Complement C5a