[Risk factors of acute rejection in sensitized kidney transplant recipients].
OBJECTIVE
To identify the risk factors of acute rejection in sensitized recipients undergoing kidney transplantation.


METHODS
The clinical data of 102 sensitized kidney transplant recipients were retrospectively analyzed to evaluate the incidence of acute rejection in relation to panel reactive antibodies (PRA), amino acid residual match, postoperative elevation of PRA level and cytokine genotypes.


RESULTS
During the follow-up, acute rejection occurred in totally 33 patients, and the incidence was higher in the recipients with high tumor necrosis factor (TNF)-alpha or high interleukin (IL)-10 producer genotype than in those with low TNF-alpha or low/intermediate IL-10 producer genotype (53.1%, 55.0% vs 22.8%, 20.9%, P(18)0.01 respectively). Acute rejection was even more frequent in the recipients with both high TNF-alpha and high/intermediate IL-10 producer genotypes than in those with low TNF-alpha and IL-10 producer genotype (66.7% vs 10.2%, P<0.01). No relations were found between TGF-beta1, IL-6, IFN-gamma gene polymorphisms and the incidence of acute rejection. The incidence in the recipients with PRA level of more than 40% was also higher than those with lower PRA level (<20%, 53.3% vs 22.7%, P<0.05), and the amino acid residual mismatch with 3-4 MM was responsible for a higher incidence in comparison with a mismatch with 0-1 MM (75.0% vs 24.1%, P<0.01). Postoperative elevation of PRA level also increased the risk of acute rejection (45.4% vs 22.4%, P<0.01).


CONCLUSIONS
TNF-alpha, IL-10 gene polymorphism, PRA, amino acid residual mismatch, and increased postoperative PRA level may significantly influence acute rejection in sensitized kidney transplantation recipient, and preoperative evaluation of these factors may benefit the designing of immunosuppressive protocols for these patients.
Huang
Xian-en
XE
Department of Organ Transplantation, Zhujing Hospital, Southern Medical University, Guangzhou 510282, China.
Fan
Li-pei
LP
Li
Liu-yang
LY
Zhao
Ming
M
Xia
Sui-sheng
SS
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology; D000917:Antibody Formation; D002681:China / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016753:Interleukin-10 / Q000096:biosynthesis* / Q000235:genetics; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis / Q000235:genetics
D000906:Antibodies; D007518:Isoantibodies; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10