Pretransplant inflammation: a risk factor for delayed graft function?
BACKGROUND
Inflammation plays an important role in the pathogenesis of ischemic acute kidney injury (IAKI). In this study, we hypothesize that transplant recipients with pretransplant inflammation may have a greater chance of developing delayed graft function (DGF), an example of IAKI.


METHODS
We analyzed 178 patients who had undergone their first transplant using cadaveric donors. Blood samples were extracted from transplant recipients prior to transplantation. C-reactive protein (CRP) (nephelometry); interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) (automatized enzyme chemiluminescence immunometric assay); and pregnancy-associated plasma protein A (PAPP-A) (enzyme-linked immunosorbent assay) were determined using the pretransplant blood samples. The risk factors analyzed included cold ischemia, type and time of dialysis, donor and recipient age and HLA compatibility.


RESULTS
Sixty-one patients (34.3%) developed DGF. Pretransplant TNF-alpha (9.31 +/- 2.57 vs. 10.56 +/- 3.82 pg/mL; p=0.039) and PAPP-A (1.25 +/- 0.74 vs. 1.90 +/- 1.56 mU/L; p=0.002) were significantly elevated in the group of patients with DGF. Univariate analysis showed that PAPP-A, TNF-alpha, cold ischemia, type of dialysis (hemodialysis) and donor age were associated with DGF. Multivariate analysis showed that PAPP-A (p=0.006), cold ischemia (p=0.009) and type of dialysis (p=0.046) were independent risk factors for DGF.


CONCLUSIONS
Pretransplant inflammation (TNF-alpha, PAPP-A) in transplant recipients could be a risk factor for the development of DGF.
Lauzurica
Ricardo
R
Department of Nephrology, Hospital Universitario Germans Trias i Pujol, Universidad Autonoma de Barcelona, Badalona, Spain. rlauzurica.germanstrias@gencat.net
Pastor
Mari Cruz
MC
Bayés
Beatriz
B
Hernandez
Jose María
JM
Bonet
Josep
J
Doladé
María
M
Navarro
Maru
M
Romero
Ramón
R
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002102:Cadaver; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D006801:Humans; D007249:Inflammation; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D015427:Reperfusion Injury / Q000209:etiology; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D011266:Pregnancy-Associated Plasma Protein-A