sCD30 and neopterin as risk factors of chronic renal transplant rejection: impact of cyclosporine A, tacrolimus, and mycophenolate mofetil.
High pretransplantation sCD30 levels have been shown to be associated with lower 5-year kidney graft survival in mainly Cyclosporine A (CsA)-treated recipients (Collaborative Transplant Study database). To analyze the effect of different immunosupressive regimens (CsA/Azathioprine [Aza], CsA/Mycophenolate Mofetil [MMF], Tacrolimus [Tacr]/Aza) on sCD30, we assessed serum sCD30 and neopterin together with in vitro cytokine responses in a prospective randomized study of 84 renal transplant recipients before, 4 months, and 1 year after transplantation. Panel-reactive antibody (PRA) formation, HLA matching, ATG induction therapy, and acute rejections had no impact on sCD30 levels, whereas cytomegalovirus (CMV) infections induced an up-regulation of sCD30 4 months posttransplantation (P = .003). Whereas MMF showed no effect on sCD30 compared with Aza therapy, we found a significant impact of Tacr versus CsA treatment (1-year sCD30 > or = 60 U/mL: 14/42 (33%), CsA; 1/38 (3%), Tacr; P < .0005). Chronic rejection 2 years posttransplantation was associated with elevated 1-year sCD30 (P = .001) and neopterin levels (P = .006). Our data indicate that the Th2 activation marker sCD30 provides a risk factor for chronic rejection independent of classical immunological risk factors and may be down-regulated using Tacr treatment.
Weimer
R
R
Department of Internal Medicine, University of Giessen, Giessen, Germany. rolf.weimer@innere.med.uni-giessen.de
Süsal
C
C
Yildiz
S
S
Streller
S
S
Pelzl
S
S
Staak
A
A
Renner
F
F
Dietrich
H
H
Daniel
V
V
Feuring
E
E
Kamali-Ernst
S
S
Ernst
W
W
Padberg
W
W
Opelz
G
G
D015703:Antigens, CD / Q000097:blood; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use*; D016207:Cytokines / Q000276:immunology; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017730:Ki-1 Antigen / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use*
D015703:Antigens, CD; D016207:Cytokines; D007166:Immunosuppressive Agents; D017730:Ki-1 Antigen; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus