title: Plasma and urine leukocyte elastase-alpha1protease inhibitor complex as a marker of early and long-term kidney graft function.
abstract: BACKGROUND
  Neutrophils are mediators of ischaemia/reperfusion (I/R) injury following kidney transplantation (kTx). Leukocyte elastase (LE) complex with alpha(1)protease inhibitor (LE-alpha(1)PI) is a marker of neutrophil degranulation. The aim of this study was to evaluate LE-alpha(1)PI as a marker of I/R kidney damage and to search for correlations between leukocyte activation and post-transplant complications.
  
  
  METHODS
  Plasma and urine LE-alpha(1)PI were estimated in 55 deceased-donor kidney graft recipients on postoperative days (POD) 1, 3 and 7, as well as in the late post-transplant period.
  
  
  RESULTS
  The plasma LE-alpha(1)PI level peaked on POD 1 after kTx, and the urine LE-alpha(1)PI peaked on POD 3. On POD 1 and POD 3, the urine LE-alpha(1)PI levels were higher in delayed graft function (DGF) patients than in patients with immediate graft function (IGF: P < 0.001 and P < 0.003, respectively). Urine LE-alpha(1)PI excretion on POD 1 was significantly higher in patients with longer cold ischaemia time (CIT) than in patients with shorter CIT, P < 0.002. Multivariate regression model revealed two factors influencing the occurrence of early acute rejection-urine LE-alpha(1)PI complex on POD 3 and human leukocyte antigen (HLA) mismatches. There was a significant association between the plasma LE-alpha(1)PI on POD 3 and serum creatinine level 6 and 12 months after kTx (r(2) 0.24; P < 0.005 and 0.19; P < 0.005, respectively).
  
  
  CONCLUSIONS
  This study is the first presentation of a simple, non-invasive measurement of neutrophil activation after kTx. It also demonstrates a strong correlation between the early post-transplant LE-alpha(1)PI complex level and kidney graft function.
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. malgorzata.litwin@gmail.com
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Zynek-Litwin
authors.forename: Jakub
authors.initials: J
authors.lastname: Kuzniar
authors.forename: Zofia
authors.initials: Z
authors.lastname: Marchewka
authors.forename: Waclaw
authors.initials: W
authors.lastname: Kopec
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kusztal
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patrzalek
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Biecek
authors.forename: Marian
authors.initials: M
authors.lastname: Klinger
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D019272:Leukocyte Elastase / Q000097:blood* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018375:Neutrophil Activation; D011237:Predictive Value of Tests; D011480:Protease Inhibitors / Q000097:blood* / Q000652:urine*; D012189:Retrospective Studies; D000515:alpha 1-Antitrypsin / Q000097:blood / Q000652:urine
chemical_list: D015415:Biomarkers; D011480:Protease Inhibitors; D000515:alpha 1-Antitrypsin; D019272:Leukocyte Elastase