Inflammation in renal transplantation.
OBJECTIVE
Renal transplant recipients experience premature cardiovascular disease and death. The association of inflammation, all-cause mortality, and cardiovascular events in renal transplant recipients has not been examined in a large prospective controlled trial.


METHODS
ALERT was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin on cardiovascular and renal outcomes in 2102 renal transplant recipients. Patients initially randomized to fluvastatin or placebo in the 5- to 6-yr trial were offered open-label fluvastatin in a 2-yr extension to the original study. The association between inflammation markers, high-sensitivity C-reactive protein (hsCRP), and IL-6 on cardiovascular events and all-cause mortality was investigated.


RESULTS
The baseline IL-6 value was 2.9 +/- 1.9 pg/ml (n = 1751) and that of hsCRP was 3.8 +/- 6.7 mg/L (n = 1910). After adjustment for baseline values for established risk factors, the hazard ratios for a major cardiac event and all-cause mortality for IL-6 were 1.08 [95% confidence interval (CI), 1.01 to 1.15, P = 0.018] and 1.11 (95% CI, 1.05 to 1.18, P < 0.001), respectively. The adjusted hazard ratio for hsCRP for a cardiovascular event was 1.10 (95% CI, 1.01 to 1.20, P = 0.027) and for all-cause mortality was 1.15 (95% CI, 1.06 to 1.1.25, P = 0.049).


CONCLUSIONS
The inflammation markers IL-6 and hsCRP are independently associated with major cardiovascular events and all-cause mortality in renal transplant recipients.
Abedini
Sadollah
S
Renal Section, Department of Medicine, Toensberg County Hospital, Toensberg, Norway. Sadollah.abedini@gmail.com
Holme
Ingar
I
März
Winfried
W
Weihrauch
Gisela
G
Fellström
Bengt
B
Jardine
Alan
A
Cole
Edward
E
Maes
Bart
B
Neumayer
Hans-Hellmut
HH
Grønhagen-Riska
Carola
C
Ambühl
Patrice
P
Holdaas
Hallvard
H
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000401:mortality*; D015850:Interleukin-6 / Q000097:blood; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors
C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein