title: Low pretransplantation mannose-binding lectin levels predict superior patient and graft survival after simultaneous pancreas-kidney transplantation.
abstract: Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for patients with type 1 diabetes and renal failure. However, this procedure is characterized by a high rate of postoperative infections, acute rejection episodes, and cardiovascular mortality. The lectin pathway of complement activation contributes to cardiovascular disease in diabetes and may play an important role in inflammatory damage after organ transplantation. This study therefore sought to determine how mannose-binding lectin (MBL), a major recognition molecule of the lectin pathway of complement activation, influences outcome after SPKT. MBL serum levels were determined in 99 and MBL genotypes in 97 consecutive patients who received an SPKT from 1990 through 2000 and related to patient and graft survival. At 12 yr, cumulative death-censored kidney graft survival was 87.5% in patients with an MBL level <400 ng/ml and 74.8% in the group with MBL levels >400 ng/ml (P = 0.021). Pancreas graft survival was significantly better in patients with low MBL levels (P = 0.016). MBL levels >400 ng/ml were associated with a hazard ratio of 6.28 for patient death (95% confidence interval 1.8 to 20.3; P = 0.003). Accordingly, survival was significantly better in recipients with MBL gene polymorphisms associated with low MBL levels. These findings identify MBL as a potential risk factor for graft and patient survival in SPKT. It is hypothesized that MBL contributes to the pathogenesis of inflammation-induced vascular damage both in the transplanted organs and in the recipient's native blood vessels.
authors.affiliation: Department of Nephrology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands.
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Berger
authors.forename: Anja
authors.initials: A
authors.lastname: Roos
authors.forename: Marko J K
authors.initials: MJ
authors.lastname: Mallat
authors.forename: Alexander F M
authors.initials: AF
authors.lastname: Schaapherder
authors.forename: Ilias I
authors.initials: II
authors.lastname: Doxiadis
authors.forename: Cees
authors.initials: C
authors.lastname: van Kooten
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: Mohamed R
authors.initials: MR
authors.lastname: Daha
authors.forename: Johan W
authors.initials: JW
authors.lastname: de Fijter
mesh_terms: D000328:Adult; D003167:Complement Activation; D003928:Diabetic Nephropathies / Q000401:mortality / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood* / Q000276:immunology*; D008875:Middle Aged; D016035:Pancreas Transplantation; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012307:Risk Factors
chemical_list: D037601:Mannose-Binding Lectin