title: Plasminogen activator inhibitor-1 polymorphism is associated with progressive renal dysfunction after acute rejection in renal transplant recipients.
abstract: BACKGROUND
  Plasma level of plasminogen activator inhibitor (PAI)-1 is genetically determined by a polymorphism in the promoter region, involving two alleles, 4G and 5G. Plasma PAI-1 concentrations are higher in subjects homozygous for the 4G allele than other genotypes (5G/5G and 4G/5G). Such genetic variation in fibrinolytic system may affect the long-term renal transplant outcome.
  
  
  METHODS
  We determined PAI-1 4G/5G-promoter genotype polymorphism among our renal transplant recipients between 1985 and 2001. Primary event was defined as doubling of baseline serum-creatinine level.
  
  
  RESULTS
  Over a median period of 79 months, 130 patients with 132 kidney grafts were assessed. Baseline clinical variables were comparable among three genotype groups. There was no association between primary event and PAI-1 genotype among the entire cohort. However, among subjects with prior acute rejection episodes, those homozygous for 4G had significantly higher risk of serum creatinine doubling than the other two genotypes (relative risk 2.45, 95% confidence interval 1.19-5.04). PAI-1 genotype does not predict primary events in patients without rejection (relative risk 0.57, 95% confidence interval 0.07-4.17).
  
  
  CONCLUSIONS
  PAI-1 4G/5G-promoter polymorphism modulates the risk of renal transplant outcomes after acute rejection(s). Recipients homozygous for PAI-1 4G allele have a higher risk of progressive renal damage after acute rejection episode(s). PAI-1 promoter polymorphisms are potentially important determinants of renal response to rejection.
authors.affiliation: Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Kai Ming
authors.initials: KM
authors.lastname: Chow
authors.forename: Cheuk Chun
authors.initials: CC
authors.lastname: Szeto
authors.forename: Carol Yi-Ki
authors.initials: CY
authors.lastname: Szeto
authors.forename: Peter
authors.initials: P
authors.lastname: Poon
authors.forename: Fernand Mac-Moune
authors.initials: FM
authors.lastname: Lai
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006084:Graft Rejection / Q000235:genetics* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics*; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D017395:Plasminogen Activator Inhibitor 1