Infectious complications after simultaneous pancreas-kidney transplantation: a role for the lectin pathway of complement activation.
BACKGROUND
Mannose-binding lectin (MBL) is a recognition molecule of the lectin pathway of complement activation, and its serum levels are largely determined by frequently occurring polymorphisms of the MBL gene. We questioned whether MBL deficiency influences infectious complications in patients after simultaneous pancreas-kidney transplantation (SPKT).


METHODS
Infectious complications in the first year after transplantation were scored retrospectively in 152 consecutive SPKT patients who received their transplant at our center between 1990 and 2005. Pretransplant serum MBL levels were determined with enzyme-linked immunosorbent assay.


RESULTS
Every 500 ng/mL increase in baseline MBL was associated with an odds ratio of 0.83 (P=0.045) for urinary tract infections and an odds ratio of 0.68 (P=0.029) for urosepsis. Urosepsis was significantly more common in patients with low baseline MBL (<400 ng/mL) compared with those with greater MBL levels (22.7% vs. 8.3%, P=0.015). No significant influence of MBL on the occurrence of wound infections and cytomegalovirus disease could be demonstrated.


CONCLUSIONS
With the current study, we show that high levels of serum MBL are associated with protection against urinary tract infections and, more specifically, against urosepsis after SPKT. These data indicate an important role for the lectin pathway of complement activation in antimicrobial defense in these transplant recipients.
Verschuren
Jeffrey J W
JJ
Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
Roos
Anja
A
Schaapherder
Alexander F M
AF
Mallat
Marko J K
MJ
Daha
Mohamed R
MR
de Fijter
Johan W
JW
Berger
Stefan P
SP
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003167:Complement Activation / Q000276:immunology / Q000502:physiology*; D004198:Disease Susceptibility; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007113:Immunity, Innate / Q000276:immunology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood / Q000502:physiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000209:etiology*; D014552:Urinary Tract Infections / Q000097:blood / Q000209:etiology*
D015415:Biomarkers; D037601:Mannose-Binding Lectin