Lipopolysaccharide-binding-protein as a new and reliable infection marker after kidney transplantation

Abstract

Lipopolysaccharide-binding protein as a new and reliable infection marker after kidney transplantationAbstract The early and reliable differentiation of rejections, viral infections and bacterial infections is one of the main problems after organ transplantation. One promising solution to this problem is the lipopolysaccharide-binding protein (LBP), which is regulated upwards in gram-negative sepsis and related conditions. Therefore, the aim of our study was to explore the diagnostic potential of LBP serum levels in well-defined, non-infectious and infectious events after kidney transpIantation (KTx). In a retrospective study the LBP serum levels were measured in a total of 686 serum samples from 52 kidney graft recipients. In all pre-KTx sera tested, the mean LBP level was 8.8 i 3.5 pg/ml (reference range: 2.0-1 5.2 pg/ml). In 7 of 52 recipients without intraoperative T-cell depletion, the mean LBP level was significantly (P < 0.01) increased (13.0k 1.5 pg/ml) at post-KTx day 1, but was within the reference range. In contrast, the intraoperative T-cell depletion by antilymphocyte antibodies resulted in a significant (P < 0.01) increase to 25.8 =t 11.4 pg/ml (range: 13.3-47.2 pg/ml). In recipients with immediate (n= 14) or delayed ( n = 9 ) graft function without any other complications, all post-KTx values (except the post-KTx peak) were within the reference range. In 10 recipients with steroid-sensitive rejections and in 11 recipients with steroid-resistant rejections, no rejection-associated changes of the LBP levels could be shown. In six recipients with cytomegalovirus infection, the detection of an antigenemia (pp65) also was not associated with alterations of the LBP levels. In addition, there was no correlation between LBP levels and the number of pp65-positive leukocytes in peripheral blood. In contrast, a strong elevation of LBP levels was seen in five recipients with gram-positive bacteremia as well as in other severe bacterial infections (e.g., purulent extravasate, heavily infected grafts, bacterial pneumonia and contaminated hematoma). In two recipients with superinfected (bacterial and mycotic or viral) Pneumocystis carinii pneumonias requiring assisted ventilation, LBP levels were elevated, too. Thus, in our study only systemic non-viral infections and massive lymphocytolysis were associated with elevated LBP serum levels.

Lipopolysaccharide‐Binding Protein Serum Levels in Patients with Severe Sepsis Due to Gram‐Positive and Fungal Infections

“…Until now, there have been limited data on LBP serum levels in gram-positive and fungal infections [6,[10][11][12][13]. Opal et al [6] described increased LBP serum levels in patients with grampositive and fungal infections, but LBP serum levels in patients with gram-negative bacteremia were significantly higher.…”

“…One study performed in patients with chronic ambulatory peritoneal dialysis has described elevated LBP serum levels in peritoneal efflux of patients suffering from gram-negative and gram-positive peritonitis [14], but no corresponding LBP serum levels were provided. Kaden et al [10] described elevated LBP serum levels in 2 patients, who had undergone kidney transplantation, with Pneumocystis carinii pneumonia complicated by mycotic superinfection. However, no information on pure or mixed mycotic infections due to common fungus, such as Candida species, were given.…”

“…Several studies have reported increased LBP serum levels in adults and in neonates with gram-positive infections [6,[10][11][12][13]. In one study performed in patients with chronic renal failure and peritonitis secondary to gram-positive agents, increased LBP serum levels have been observed in peritoneal fluid samples, but there were no data for concomitant serum levels [14].…”

“…In one study performed in patients with chronic renal failure and peritonitis secondary to gram-positive agents, increased LBP serum levels have been observed in peritoneal fluid samples, but there were no data for concomitant serum levels [14]. Kaden et al [10] have reported an increase in LBP serum levels in 2 patients with Pneumocystis carinii and mycotic superinfection, who had undergone transplantation, but no detail is available for LBP serum levels in pure my- cotic infections. Nevertheless, none of these previous studies have clearly compared LBP serum levels in gram-negative, gram-positive, and fungal infections.…”

Lipopolysaccharide-Binding Protein: A New Biomarker for Infectious Endocarditis?

“…There have been 2 studies regarding the clinical value of LBP in this context. Kaden et al observed that cytomegalovirus infection is not associated with increased LBP concentrations (21 ), and Heumann and coworkers noted increased LBP concentrations in patients with rheumatic disorders (28 ). By comparison, the percent increases in LBP concentrations calculated for patients with rheumatic disorders (degenerative arthritis, 6.3%; rheumatoid arthritis, 25.8%; reactive arthritis, 46.0%) were lower than the 83.2% increase seen in our IE cohort.…”