title: Pretransplant inflammation: a risk factor for delayed graft function?
abstract: 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.
authors.affiliation: Department of Nephrology, Hospital Universitario Germans Trias i Pujol, Universidad Autonoma de Barcelona, Badalona, Spain. rlauzurica.germanstrias@gencat.net
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lauzurica
authors.forename: Mari Cruz
authors.initials: MC
authors.lastname: Pastor
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bayés
authors.forename: Jose María
authors.initials: JM
authors.lastname: Hernandez
authors.forename: Josep
authors.initials: J
authors.lastname: Bonet
authors.forename: María
authors.initials: M
authors.lastname: Doladé
authors.forename: Maru
authors.initials: M
authors.lastname: Navarro
authors.forename: Ramón
authors.initials: R
authors.lastname: Romero
mesh_terms: 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
chemical_list: D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D011266:Pregnancy-Associated Plasma Protein-A