title: Inflammation and oxidation: do they improve after kidney transplantation? Relationship with mortality after transplantation.
abstract: Patients with chronic kidney disease (CKD) are characterized by a state of inflammation and oxidative stress that seems to improve after kidney transplantation (KT). Nevertheless, there is controversy regarding what is the best marker that better define inflammation and specially oxidative stress.
  
  
  OBJECTIVE
  To evaluate the biomarkers which are associated with improvements in inflammation and lipid peroxidation in patients who have undergone KT. To evaluate the relationship between inflammation, lipid peroxidation and mortality in KT.
  
  
  METHODS
  196 KT (between 2003 and 2008). 67.9% men; median age: 51.9 years. Inflammation markers analyzed previous KT and 3 months after KT: c-reactive protein(CRP), interleukin 6(IL-6), tumor necrosis factor alpha(TNFα), soluble tumor necrosis factor receptor alpha(sTNFRα), soluble interleukin-2 receptor (sIL-2R). Lipid peroxidation markers analyzed: oxidized low-density lipoprotein (oxLDL) and anti-oxLDL antibodies. Calculation of glomerular filtration rate after KT: MDRD equation.
  
  
  RESULTS
  Following KT, there is a significant decrease in CRP (p = 0.006), IL-6 (p = 0.0037), TNFα (p < 0.0001), sTNFRα (p < 0.0001) and sIL-2R (p < 0.0001), while levels of oxLDL increase after KT (p < 0.0001) and there is not a significantly difference in anti-oxLDL. 12.8% of the patients had died in 2012. These patients had higher levels of IL-6 (p = 0.011) and sTNFRα (p < 0.006) after KT and a lower MDRD (p < 0.0001), hemoglobin (p = 0.012) and albumin (p = 0.007). We observed no statistically differences in the levels of markers previous KT. Of the patients who died, the 43.5% of them had anti-oxLDL antibody levels greater than 75th percentile (P75: 3781 UI/ml, p = 0.028). In the multivariate analysis, age (OR:1.12; p = 0.0129), MDRD (OR:0.92; p = 0.013) and P75of anti-oxLDL(OR: 5.19; p = 0.026) were independent risk factors for mortality. Independent risk factors for survival were: P75of IL-6 (HR: 2.45; p = 0.027), oxLDL (HR:19.85; p = 0.002) and anti-oxLDL (HR: 9.55; p = 0.003).
  
  
  CONCLUSIONS
  KT improved inflammation but not lipid oxidative state. KT patients who died had a higher inflammatory state (with higher levels of IL-6 and sTNFRα), a worse lipid oxidative state and a worse renal function 3 months after KT. Age, anti-oxLDL and renal function at 3 months after KT were independent risk factors for mortality.
authors.affiliation: Department of Nephrology, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Red de Investigacion Renal (RedinRen), CTRA. Canyet s/n, 08916, Badalona, Barcelona, Spain. laucanyas78@hotmail.com.
authors.forename: Laura
authors.identifier: http://orcid.org/0000-0002-4627-378X
authors.initials: L
authors.lastname: Cañas
authors.affiliation: Department of Clinical Biochemistry, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Iglesias
authors.affiliation: Department of Clinical Biochemistry, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: María Cruz
authors.initials: MC
authors.lastname: Pastor
authors.affiliation: Department of Clinical Biochemistry, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Barallat
authors.affiliation: Department of Nephrology, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Red de Investigacion Renal (RedinRen), CTRA. Canyet s/n, 08916, Badalona, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Juega
authors.affiliation: Department of Nephrology, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Red de Investigacion Renal (RedinRen), CTRA. Canyet s/n, 08916, Badalona, Barcelona, Spain.
authors.forename: Ioana
authors.initials: I
authors.lastname: Bancu
authors.affiliation: Department of Nephrology, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Red de Investigacion Renal (RedinRen), CTRA. Canyet s/n, 08916, Badalona, Barcelona, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lauzurica
mesh_terms: D000367:Age Factors; D000906:Antibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016030:Kidney Transplantation / Q000401:mortality; D015227:Lipid Peroxidation; D008077:Lipoproteins, LDL / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D015375:Receptors, Interleukin-2 / Q000097:blood; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology* / Q000601:surgery; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000906:Antibodies; D015415:Biomarkers; D006454:Hemoglobins; D015850:Interleukin-6; D008077:Lipoproteins, LDL; D015375:Receptors, Interleukin-2; D018124:Receptors, Tumor Necrosis Factor; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; C099252:oxidized low density lipoprotein; D002097:C-Reactive Protein
keywords: Immunosuppression; Inflammation biomarkers; Kidney transplant; Lipid peroxidation biomarkers; Mortality