Evaluation of the coagulation and inflammatory responses in solid organ transplant recipients and donors.
New strategies that modify the coagulation/inflammatory cascades may be applicable to solid organ transplant (SOT) recipients in the treatment of complications. However, data on kinetics of post-SOT cascades are needed before considering these strategies. Prospectively collected pre-transplant serum measurements of inflammatory (high-sensitive C-reactive protein, HS-CRP) and coagulation (d-Dimer, DD; protein C, PC) markers were compared to post-operative (day 1-90) values in deceased-donor liver (DDLT) and renal (DDRT) transplant recipients, living-related renal recipients (LRT) and donors (LRD). A total of 85 SOT were enrolled: 25 DDLT, 32 DDRT/LRT, 28 LRD. HS-CRP increased in all groups, mainly immediate post-SOT and in LRDs. DD had a similar pattern mainly in LRT and LRD. PC increased significantly over time in the DDLT group ( p < 0.01). Compared to those with no complications (infection, rejection or thrombosis), day 30 HS-CRP (p = 0.04) and DD (p = 0.06) were elevated in the DDRT/LRT group with complications; PC was decreased at day 7 (p = 0.04) and day 30 (p = 0.009) in DDLT and DDRT/LRT groups with complications, respectively. In conclusion, activation of the inflammatory/coagulation cascades occurs after SOT and is least pronounced in DDLT. This activation diminishes over time unless transplant complications occur. Our results support further research in approaches to altering these cascades in SOT recipients.
Levitsky
Josh
J
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Freifeld
Alison
A
Lyden
Elizabeth
E
Stoner
Julie
J
Florescu
Diana
D
Langnas
Alan
A
Brian Stevens
R
R
Hardiman
Penny
P
Hill
Lisa
L
Kalil
Andre C
AC
D000328:Adult; D015415:Biomarkers / Q000097:blood*; D001777:Blood Coagulation / Q000502:physiology*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood*; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; C036309:fibrin fragment D; D002097:C-Reactive Protein