Assessment of pretransplant inflammation in pediatric renal allograft recipients

Abstract

Summary Pretransplant (Tx) inflammation is linked to adverse outcomes in adult Tx recipients but no such data exist for children. Our study evaluated the predictive value of three pre‐Tx inflammatory markers: serum C‐reactive protein (CRP), Neopterin (Neo) and interleukin (IL) 12, in determining outcome. Pre‐Tx serum on 51 children (mean age 11 years) transplanted between 1985 and 2000 was analyzed. Data on other variables were abstracted from patient records. Primary end‐points were graft survival and acute rejection (AR). Kaplan‐Meier and log‐rank statistics compared endpoints in patients at different quartiles for each marker. Cox regression analysis was used to determine the independent effect of the markers on the end‐points. The mean CRP, Neo, and IL‐12 were 1.3 mg/l, 1.78 ng/ml, and 123 pg/ml, respectively. The mean CRP, Neo, and IL‐12 were not different between the patients with and without AR or graft loss (P > 0.4 for all). Neither rejection‐free survival nor graft survival was affected by CRP, Neo, or IL‐12 quartiles. Cox‐regression analysis demonstrated no predictive value of any marker on outcome. Unlike adults, a single pre‐Tx determination of inflammatory markers was not predictive of AR or graft loss in children, indicating that the pathogenesis of AR may be different in children.

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“…The effect of inflammatory markers as predictors of acute rejection and graft failure has been studied. 6,7 A study in IL-6 knockout rats showed longer graft survival and fewer episodes of rejection after a kidney transplant compared with normal rats. 8 Increased urinary IL-6, tumor necrosis factor receptor 1, and vascular cell adhesion molecule 1 levels may predict early acute rejection.…”

The Role of Midkine in the Inflammatory Process and Its Correlation with Other Inflammatory Markers in Renal Transplant Recipients

“…In the chronic phase, humoral and cellular immune reactivity adds to the events. Lately, it has been questioned whether pretransplant levels of inflammatory markers could be used as predictors of acute rejection and graft loss (19,20). In a study by Cicora et al, tacrolimus or rapamycin was given to donor rats before the transplantation process.…”

“…Ischemia reperfusion injury in particular leads to an intense inflammatory storm (12). There are new studies investigating whether inflammation markers could be used as a predictor of graft loss (19,20). The role of IL-6 is particularly important and has been confirmed both by animal and human studies.…”

Evaluation of neopterin levels in patients undergoing hemodialysis

“…Neopterin has been reported to be a useful marker in detecting graft rejection and cytomegalovirus infection in kidney transplant recipients 3,19–29 . In contrast, the information about interrelation between neopterin and glomerulonephritis has been very limited 30–32 .…”

“…Neopterin has been reported to be a useful marker in detecting graft rejection and cytomegalovirus infection in kidney transplant recipients. 3,[19][20][21][22][23][24][25][26][27][28][29] In contrast, the information about interrelation between neopterin and glomerulonephritis has been very limited. [30][31][32] Godai et al 10 reported that urinary neopterin was a valuable marker for the differential diagnosis of membranous nephropathy associated with hepatitis B surface antigenemia and yet to serve as a prognostic indicator.…”