Clinical analysis of perioperative complement activity during ischemia/reperfusion injury following renal transplantation.
OBJECTIVE
The complement cascade seems to be an important mediator modulating renal ischemia/reperfusion injury. This study analyzed whether significant changes occur in the levels of a terminal panel of complement molecules (C3a, C5a, and C5b-9/membrane attack complex) during the early phase of human kidney allograft reperfusion and evaluated the potential association of these changes with clinical post-transplant graft function in kidney transplant recipients.


METHODS
Seventy-five renal transplant recipients undergoing transplantation between 2004 and 2006 were enrolled in the study and divided into early, slow, and delayed graft function groups. Blood samples were collected perioperatively during consecutive minutes of allograft reperfusion from the renal vein. Levels of complement molecules were measured using ELISA.


RESULTS
Analysis revealed no significant changes in C3a and C5a levels throughout reperfusion. The main complement molecule that was significantly associated with post-transplant graft function was C5b-9/membrane attack complex; throughout the reperfusion period, perioperative levels of C5b-9/membrane attack complex were around two to three times higher in delayed graft function patients than early and slow graft function individuals (P<0.005). In addition, C5b-9/membrane attack complex levels had a relatively high clinical sensitivity and specificity (70%-87.5%) for the prediction of early and long-term (1 year) post-transplant allograft function.


CONCLUSIONS
This clinical study supports a role for the complement cascade in delayed graft function development. However, additional studies are needed to elucidate the exact mechanisms responsible for this phenomenon. In addition, perioperative measurements of C5b-9/membrane attack complex are highlighted as promising potential clinical markers of post-transplant renal allograft function.
Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland. drannab@wp.pl
Wojciech
W
Błogowski
Barbara
B
Dołęgowska
Daria
D
Sałata
Marta
M
Budkowska
Leszek
L
Domański
Teresa
T
Starzyńska
D000328:Adult; D015926:Complement C3a / Q000032:analysis; D015936:Complement C5a / Q000032:analysis; D015938:Complement Membrane Attack Complex / Q000032:analysis; D003165:Complement System Proteins / Q000032:analysis*; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012372:ROC Curve; D015427:Reperfusion Injury / Q000276:immunology*; D012189:Retrospective Studies
D015938:Complement Membrane Attack Complex; D015926:Complement C3a; D015936:Complement C5a; D003165:Complement System Proteins