Prediction of subclinical renal allograft rejection by vascular endothelial growth factor in serum and urine.
BACKGROUND
Until now subclinical renal allograft rejection has only been recognized through a protocol biopsy. The aim of this study was to assess whether measurement of vascular endothelial growth factor (VEGF) in serum and urine could be adopted as a new noninvasive tool to predict subclinical rejection.


METHODS
Concentration of VEGF in serum and urine was determined by ELISA in 132 recipients of a renal allograft with stable renal transplant function who were to undergo protocol biopsy and 80 healthy controls. A conventional receiver operating characteristic (ROC) curve was used to determine the sensitivities and specificities for patients with subclinical rejection.


RESULTS
Levels of VEGF in serum (126.96 +/- 20.13 pg/mL; 95% confidence interval [95% CI], 83.10-170.83) and urine (16.14 +/- 4.09 ng/mmol creatinine; 95% CI, 7.21-25.06) of 13 patients with subclinical rejection significantly differed from those of 119 patients with no allograft rejection (No-AR) and health controls. The areas under the ROC curve were 0.771 (95% CI, 0.0.64-0.901) and 0.819 (95% CI, 0.662-0.976), respectively. Levels of VEGF in serum and urine after antirejection therapy (50.45 +/- 6.58 pg/mL and 2.60 +/- 0.83 ng/mmol creatinine, respectively) were lower than those at the time of protocol biopsy. No difference in urinary and serum VEGF expression was observed between cyclosporine and tacrolimus treatment.


CONCLUSIONS
It is first reported that the monitoring of VEGF in serum and urine might be a new noninvasive approach to supplement a protocol biopsy for detection of subclinical rejection.
Peng
W
W
Department of Nephrology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou - PR China.
Chen
J
J
Jiang
Y
Y
Shou
Z
Z
Chen
Y
Y
Wang
H
H
D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001706:Biopsy; D003937:Diagnosis, Differential; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000097:blood* / Q000652:urine*
D015415:Biomarkers; D007166:Immunosuppressive Agents; D042461:Vascular Endothelial Growth Factor A