title: Predictive value of pretransplant inflammatory markers in renal allograft survival and rejection in children.
abstract: Pretransplant (pre-Tx) inflammation has been associated with acute rejection (AR) in adult Tx recipients. Our study was performed to determine whether a single pre-Tx serum C-reactive protein (CRP), Neopterin (Neo), and IL-12 determination could predict outcome in pediatric renal Tx recipients. Pre-Tx sera from 51 children transplanted between 1985 and 2000 were analyzed for serum CRP, Neo, and IL-12 for correlation with Tx-related variables. Endpoints were graft loss and AR. Kaplan-Meier and log-rank statistics were used to compare rejection-free and overall graft survival at different quartiles for each marker. Cox regression analysis was performed to determine the independent effects of various pre-Tx variables on the endpoints. The mean age of the children at Tx was 11 years. The mean CRP, Neo, and IL-12 were 1.3 mg/L, 1.78 ng/mL and 123 pg/mL, respectively. At last-follow-up (mean 4.9 years after Tx), 50% of the children had experienced AR and 29% had lost their grafts. The mean CRP, Neo, and IL-12 were not different between the patients with versus without AR or graft loss (P > .4 for all). Neither rejection-free survival nor graft survival was affected by CRP, Neo, or IL-12 quartiles (log-rank test). Cox regression analysis demonstrated no predictive value of any marker on the outcomes. Unlike adults, a single pre-Tx determination of inflammatory markers was not predictive of AR or graft loss in children. The pathogenesis of AR may be different in children with a lesser contribution of alloantigen-independent factors such as chronic infections.
authors.affiliation: Section of Pediatric Nephrology, University of California, Davis Medical Center, Sacramento, California 95817, USA. lavjay.butani@ucdmc.ucdavis.edu
authors.forename: L
authors.initials: L
authors.lastname: Butani
authors.forename: J
authors.initials: J
authors.lastname: Johnson
authors.forename: C
authors.initials: C
authors.lastname: Troppmann
authors.forename: J
authors.initials: J
authors.lastname: McVicar
authors.forename: R V
authors.initials: RV
authors.lastname: Perez
mesh_terms: D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007249:Inflammation / Q000276:immunology*; D018664:Interleukin-12 / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D019798:Neopterin / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018664:Interleukin-12; D019798:Neopterin; D002097:C-Reactive Protein