title: Prediction of Long-term Renal Allograft Outcome By Early Urinary CXCL10 Chemokine Levels.
abstract: Predictive biomarkers for long-term renal allograft outcome could help to individualize follow-up strategies and therapeutic interventions.
  
  
  METHODS
  We investigated the predictive value of urinary CXC chemokine ligand 10 (CXCL10) measured at different timepoints (ie, at 3 and 6 months, and mean of 3 and 6 months coined CXCL10-burden) for long-term allograft outcomes in 154 patients. The primary outcome was a composite graft endpoint of death-censored allograft loss and/or biopsy-proven rejection and/or decline of estimated glomerular filtration rate greater than 20% occurring beyond 6 months after transplantation.
  
  
  RESULTS
  After a median follow-up of 6.6 years (interquartile range, 5.7-7.5 years) the endpoint was reached in 43/154 patients (28%). In a multivariable Cox-regression model independent predictors were 6-month CXCL10 levels, the CXCL10-burden, HLA-mismatches, donor age and delayed graft function while previous (sub)clinical rejection, estimated glomerular filtration rate and proteinuria at 6 months, as well as 3-month CXCL10 levels were not. Time-dependent receiver operating characteristic analysis revealed an area under the curve of 0.68 (6-month CXCL10) and 0.67 (CXCL10-burden). Grouped by optimal cutoff, low 6-month CXCL10 (<0.70 ng/mmol) was associated with a 95% endpoint-free 5-year survival compared to 78% with high 6-month CXCL10 (P = 0.0007). Only 2 of 62 patients (3%) with low 6-month CXCL10 levels (<0.70 ng/mmol) experienced late rejection or graft loss due to rejection compared to 15 of 92 patients (16%) with high 6-month CXCL10 levels (P = 0.008). Similar results were obtained when patients were grouped according to CXCL10-burden (cutoff, 1.06 ng/mmol).
  
  
  CONCLUSIONS
  Six-month urinary CXCL10 is an independent predictor for long-term graft outcome and thus might be a supplementary tool to tailor surveillance strategies and therapy.
authors: Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
authors: Patricia
authors: P
authors: Hirt-Minkowski
authors: Transplantation and Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada.; Manitoba Centre for Proteomics and Systems Biology, Health Sciences Centre, Winnipeg, Manitoba, Canada.
authors: Julie
authors: J
authors: Ho
authors: Manitoba Centre for Proteomics and Systems Biology, Health Sciences Centre, Winnipeg, Manitoba, Canada.
authors: Ang
authors: A
authors: Gao
authors: Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
authors: Patrizia
authors: P
authors: Amico
authors: Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.; Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
authors: Michael T
authors: MT
authors: Koller
authors: Institute for Pathology, University Hospital Basel, Basel, Switzerland.
authors: Helmut
authors: H
authors: Hopfer
authors: Transplantation and Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: David N
authors: DN
authors: Rush
authors: Transplantation and Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada.; Manitoba Centre for Proteomics and Systems Biology, Health Sciences Centre, Winnipeg, Manitoba, Canada.; Diagnostic Services of Manitoba, Winnipeg, Manitoba, Canada.
authors: Peter W
authors: PW
authors: Nickerson
authors: Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
authors: Stefan
authors: S
authors: Schaub