Association of high pretransplant sIL-6R plasma levels with acute tubular necrosis in kidney graft recipients.
BACKGROUND
Delayed graft function is primarily caused by acute tubular necrosis (ATN). We studied in renal transplant recipients with posttransplant graft biopsy whether an up-regulated immune system in the recipient immediately before transplantation affects the risk of developing ATN and might be relevant for the pathogenesis of ATN.


METHODS
In a retrospective study, we analyzed pretransplant and early posttransplant soluble interleukin (sIL)-1RA, interleukin (IL)-2, sIL-2R, IL-3, IL-4, IL-6, sIL-6R, IL-10, tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta2, interferon (IFN)-gamma, and neopterin plasma levels in patients with ATN (n=26). Matched patients with acute rejection (AR) (n=26) or normal posttransplant biopsy (n=26) served as controls.


RESULTS
Pretransplant sIL-6R was higher (P=0.0004) and pretransplant TGF-beta2 lower (P=0.002) in patients with ATN than in patients with normal biopsy. ROC curves showed that high pretransplant sIL-6R has a high sensitivity (77%) and high specificity (64%) for ATN (P=0.002). Posttransplant plasma sIL-6R continued to be higher in ATN patients than in patients with normal biopsy (P=0.001). Patients with acute rejection showed pre- and posttransplant sIL-6R and TGF-beta2 plasma levels similar to those of patients with normal biopsy (P=NS).


CONCLUSIONS
High pretransplant sIL-6R plasma levels are associated with an increased risk of ATN and might contribute to the development of ATN early posttransplant. Our data suggest that preactivation of the recipient's immune system increases the risk of ATN.
Sadeghi
Mahmoud
M
Department of Transplantation-Immunology, University of Heidelberg, Heidelberg, Germany. Mahmoud.Sadeghi@med.uni-heidelberg.de
Daniel
Volker
V
Naujokat
Cord
C
Mehrabi
Arianeb
A
Opelz
Gerhard
G
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D003401:Creatine / Q000097:blood; D016207:Cytokines / Q000097:blood; D003710:Demography; D005260:Female; D006084:Graft Rejection / Q000097:blood*; D006262:Health; D006801:Humans; D016030:Kidney Transplantation; D007683:Kidney Tubular Necrosis, Acute / Q000097:blood* / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D019947:Receptors, Interleukin-6 / Q000097:blood*; D012995:Solubility; D013997:Time Factors
D016207:Cytokines; D019947:Receptors, Interleukin-6; D003401:Creatine